Provider Demographics
NPI:1477751428
Name:BASHA FARHAT, JOUMANA (DMD)
Entity Type:Individual
Prefix:
First Name:JOUMANA
Middle Name:
Last Name:BASHA FARHAT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 N RAND RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4314
Mailing Address - Country:US
Mailing Address - Phone:847-259-8888
Mailing Address - Fax:847-259-8998
Practice Address - Street 1:1235 N RAND RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4314
Practice Address - Country:US
Practice Address - Phone:847-259-8888
Practice Address - Fax:847-259-8998
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist