Provider Demographics
NPI:1407072127
Name:FARBER, COREY SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:SCOTT
Last Name:FARBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3647 OAKLEAF DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2543
Mailing Address - Country:US
Mailing Address - Phone:248-242-6869
Mailing Address - Fax:
Practice Address - Street 1:23919 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1207
Practice Address - Country:US
Practice Address - Phone:313-562-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010193481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice