Healthcare Provider Details

I. General information

NPI: 1235111972
Provider Name (Legal Business Name): FOUAD N FARHAT DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15515 3RD AVE SW STE D
BURIEN WA
98166-2553
US

IV. Provider business mailing address

15515 3RD AVE SW STE D
BURIEN WA
98166-2553
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-1410
  • Fax: 206-244-9127
Mailing address:
  • Phone: 206-244-1410
  • Fax: 206-244-9127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00008754
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: