Healthcare Provider Details

I. General information

NPI: 1225425424
Provider Name (Legal Business Name): AMANA FARRKH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2015
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8949 ANTARES AVE
COLUMBUS OH
43240-2012
US

IV. Provider business mailing address

8949 ANTARES AVE
COLUMBUS OH
43240-2012
US

V. Phone/Fax

Practice location:
  • Phone: 720-401-3341
  • Fax:
Mailing address:
  • Phone: 614-808-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-024621
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: