Provider Demographics
NPI:1376195990
Name:FARAHI, MARNI ELYSE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:MARNI
Middle Name:ELYSE
Last Name:FARAHI
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ADMIRALS WAY APT 427
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-5230
Mailing Address - Country:US
Mailing Address - Phone:727-608-8798
Mailing Address - Fax:
Practice Address - Street 1:330 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-4723
Practice Address - Country:US
Practice Address - Phone:727-608-8798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0412131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics