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General NPI Number Information
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NPI Number | 1497300453
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Entity Type | Individual
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Provider Name | MATAN MOSHE FARHI DMD
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Gender | Male
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 719 BARRON BLVD
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City | GRAYSLAKE
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State | IL
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Zip | 60030-3314
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Country | US
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Telephone | 847-986-6724
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Fax | 312-561-4750
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Provider Business Mailing Address
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Address Line | 290 W ALAMEDA AVE APT 634
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City | DENVER
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State | CO
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Zip | 80223-2199
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Country | US
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Telephone | 224-374-9411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 319.021509
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DEN.00204981
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License Number State | CO
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