Provider Demographics
NPI:1316372717
Name:DR M. FARAG, PA
Entity Type:Organization
Organization Name:DR M. FARAG, PA
Other - Org Name:LAKELAND DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:FARAG
Authorized Official - Suffix:
Authorized Official - Credentials:DMS
Authorized Official - Phone:863-688-4106
Mailing Address - Street 1:2945 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2223
Mailing Address - Country:US
Mailing Address - Phone:863-688-4106
Mailing Address - Fax:863-688-5818
Practice Address - Street 1:2945 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2223
Practice Address - Country:US
Practice Address - Phone:863-688-4106
Practice Address - Fax:863-688-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty