Provider Demographics
NPI:1689050551
Name:JAMAL, FARAH (DMD)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:JAMAL
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 1:1144 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEGINS
Mailing Address - State:PA
Mailing Address - Zip Code:17938-9091
Mailing Address - Country:US
Mailing Address - Phone:516-513-9758
Mailing Address - Fax:
Practice Address - Street 1:1144 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HEGINS
Practice Address - State:PA
Practice Address - Zip Code:17938-9091
Practice Address - Country:US
Practice Address - Phone:516-513-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS040492OtherDENTAL LICENSE NUMBER
PADN002242OtherANESTHESIA PERMIT