Provider Demographics
NPI:1407217813
Name:FARAHAY SMILE CARE DDS.PA
Entity Type:Organization
Organization Name:FARAHAY SMILE CARE DDS.PA
Other - Org Name:DELUXE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:AYMEE
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-619-5393
Mailing Address - Street 1:4005 SW 152ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5919
Mailing Address - Country:US
Mailing Address - Phone:786-409-5295
Mailing Address - Fax:786-703-7908
Practice Address - Street 1:4005 SW 152ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5919
Practice Address - Country:US
Practice Address - Phone:786-409-5295
Practice Address - Fax:786-703-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN203621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty