Provider Demographics
NPI:1578085916
Name:FAITH FAMILY DENTAL
Entity Type:Organization
Organization Name:FAITH FAMILY DENTAL
Other - Org Name:AMI AGBABLI DDS.PLLC DBA FAITH FAMIY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBABLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-222-0255
Mailing Address - Street 1:1301 E ROBINSON AVE STE B5
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 E ROBINSON AVE STE B5
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5614
Practice Address - Country:US
Practice Address - Phone:479-222-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty