Provider Demographics
NPI:1124192349
Name:FARSAI, PAUL S (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:FARSAI
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HUMPHREY ST
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2569
Mailing Address - Country:US
Mailing Address - Phone:617-595-8100
Mailing Address - Fax:781-595-8155
Practice Address - Street 1:400 HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2569
Practice Address - Country:US
Practice Address - Phone:617-595-8100
Practice Address - Fax:781-595-8155
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice