Provider Demographics
NPI:1376731133
Name:AMMAR F FARRA DMD PC
Entity Type:Organization
Organization Name:AMMAR F FARRA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:FARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-245-1955
Mailing Address - Street 1:6 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2802
Mailing Address - Country:US
Mailing Address - Phone:781-245-1955
Mailing Address - Fax:781-245-0186
Practice Address - Street 1:6 ALBION ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2802
Practice Address - Country:US
Practice Address - Phone:781-245-1955
Practice Address - Fax:781-245-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190551223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11872OtherBLUE CROSS BLUE SHIELD