Provider Demographics
NPI:1366821555
Name:YASSI, FARRAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARRAH
Middle Name:
Last Name:YASSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY AT STONY BROOK HOSPITAL DENTISTRY
Mailing Address - Street 2:151 WESTCHESTER HALL
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8711
Mailing Address - Country:US
Mailing Address - Phone:631-444-2557
Mailing Address - Fax:631-444-6013
Practice Address - Street 1:SUNY AT STONY BROOK HOSPITAL DENTISTRY
Practice Address - Street 2:51 WESTCHESTER HALL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8711
Practice Address - Country:US
Practice Address - Phone:631-444-2557
Practice Address - Fax:631-444-6013
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADDS1010421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice