Provider Demographics
NPI:1255851457
Name:HABIB, FARAH N (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARAH
Middle Name:N
Last Name:HABIB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 VILLAGE CENTER DR APT 306
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2895
Mailing Address - Country:US
Mailing Address - Phone:954-552-0565
Mailing Address - Fax:
Practice Address - Street 1:375 E CENTRAL AVE
Practice Address - Street 2:SUITE 361
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:863-875-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL226971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice