Provider Demographics
NPI:1164693909
Name:AL FARES, AMAL W (DDS)
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:W
Last Name:AL FARES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DANIEL DR
Mailing Address - Street 2:SUITE #8
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8002
Mailing Address - Country:US
Mailing Address - Phone:724-550-4128
Mailing Address - Fax:
Practice Address - Street 1:110 DANIEL DR
Practice Address - Street 2:SUITE # 8
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8002
Practice Address - Country:US
Practice Address - Phone:724-550-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0373821223G0001X
WV3748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist