1841406089 NPI number — FARAHAY FAMILY DENTAL CARE, INC

Table of content: (NPI 1841406089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841406089 NPI number — FARAHAY FAMILY DENTAL CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARAHAY FAMILY DENTAL CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841406089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
522 WHEELING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-439-1204
Provider Business Mailing Address Fax Number:
740-439-9392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
522 WHEELING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-439-1204
Provider Business Practice Location Address Fax Number:
740-439-9392
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FARAHAY
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Q
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
740-439-1204

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  21896 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2663676 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1879409 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




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