Provider Demographics
NPI:1659437192
Name:FARHI, ADELINE LYDIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADELINE
Middle Name:LYDIA
Last Name:FARHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 FOX RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4906
Mailing Address - Country:US
Mailing Address - Phone:610-565-0536
Mailing Address - Fax:
Practice Address - Street 1:301 S DUPONT RD
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1082
Practice Address - Country:US
Practice Address - Phone:302-998-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00012111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000040450Medicaid