MEDICARE: DR. FARIDA FANUSWALA D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI02613500	NJ

General Provider Information

NPI Number	:	1255717583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARIDA FANUSWALA D.D.S

Provider Business Mailing Address
First Line	:	102 CARRIAGE TRL
Second Line	:
City	:	BELLE MEAD
State	:	NJ
Zip	:	08502-4910
Country	:	US
Telephone Number	:	732-666-2682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 STATE HWY NO 27
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-0890
Country	:	US
Telephone Number	:	732-666-2682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	02/24/2025

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