Provider Demographics
NPI:1477517852
Name:FARAH, CONSTANTIN F (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTIN
Middle Name:F
Last Name:FARAH
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 EXECUTIVE CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2983
Mailing Address - Country:US
Mailing Address - Phone:330-494-7004
Mailing Address - Fax:330-494-7071
Practice Address - Street 1:4410 EXECUTIVE CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2983
Practice Address - Country:US
Practice Address - Phone:330-494-7004
Practice Address - Fax:330-494-7071
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-85011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics