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General NPI Number Information
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NPI Number | 1366188922
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Entity Type | Organization
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Legal Business Name | JOHN FARAH PA
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 55 N CARPENTER RD
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City | TITUSVILLE
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State | FL
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Zip | 32796-2204
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Country | US
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Telephone | 321-269-3802
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Fax | 321-269-0920
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Provider Business Mailing Address
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Address Line | 55 N CARPENTER RD
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City | TITUSVILLE
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State | FL
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Zip | 32796-2204
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Country | US
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Telephone | 321-269-3802
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Fax | 321-269-0920
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOHN E. FARAH
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Credential | DMD
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Telephone | 321-614-0486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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