Provider Demographics
NPI:1659616050
Name:AL-FARAJE, LOUIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIE
Middle Name:
Last Name:AL-FARAJE
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 1:4710 RUFFNER ST
Mailing Address - Street 2:STE. B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1530
Mailing Address - Country:US
Mailing Address - Phone:858-496-0574
Mailing Address - Fax:858-560-1743
Practice Address - Street 1:4710 RUFFNER ST
Practice Address - Street 2:STE. B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1530
Practice Address - Country:US
Practice Address - Phone:858-496-0574
Practice Address - Fax:858-560-1743
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist