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General NPI Number Information
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NPI Number | 1316372717
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Entity Type | Organization
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Legal Business Name | DR M. FARAG, PA
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 2945 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-2223
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Country | US
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Telephone | 863-688-4106
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Fax | 863-688-5818
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Provider Business Mailing Address
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Address Line | 2945 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-2223
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Country | US
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Telephone | 863-688-4106
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Fax | 863-688-5818
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHER N FARAG
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Credential | DMS
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Telephone | 863-688-4106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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