Provider Demographics
NPI:1467942219
Name:FARHAT, MAHMOUD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:FARHAT
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 1:18590 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1872
Mailing Address - Country:US
Mailing Address - Phone:313-406-9612
Mailing Address - Fax:
Practice Address - Street 1:18590 OUTER DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128
Practice Address - Country:US
Practice Address - Phone:313-406-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010225571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice