Healthcare Provider Details

I. General information

NPI: 1992643084
Provider Name (Legal Business Name): AMJAD RYAD FARAJ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 N MAIN ST
HIGH POINT NC
27262-2133
US

IV. Provider business mailing address

4309 MILLIS RD APT 307
JAMESTOWN NC
27282-8966
US

V. Phone/Fax

Practice location:
  • Phone: 703-565-7731
  • Fax:
Mailing address:
  • Phone: 703-565-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14996
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: