Healthcare Provider Details

I. General information

NPI: 1902080054
Provider Name (Legal Business Name): PAUL FARKAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FCI LORETTO
LORETTO PA
15940
US

IV. Provider business mailing address

219 ESAU ST
HOLLIDAYSBURG PA
16648-9225
US

V. Phone/Fax

Practice location:
  • Phone: 814-471-1449
  • Fax:
Mailing address:
  • Phone: 814-471-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2891
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: