Provider Demographics
NPI:1033256193
Name:LLORENTE-FAROOQ, THELMA B (DDS)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:B
Last Name:LLORENTE-FAROOQ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:THELMA
Other - Middle Name:BL
Other - Last Name:FAROOQ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:23 BROOME BLVD
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2321
Mailing Address - Country:US
Mailing Address - Phone:845-353-2149
Mailing Address - Fax:
Practice Address - Street 1:11 WILBUR RD
Practice Address - Street 2:
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984-0470
Practice Address - Country:US
Practice Address - Phone:845-947-6203
Practice Address - Fax:845-947-6209
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist