Provider Demographics
NPI:1689763401
Name:FARAG, MAHER NASHED (BDMS)
Entity Type:Individual
Prefix:DR
First Name:MAHER
Middle Name:NASHED
Last Name:FARAG
Suffix:
Gender:M
Credentials:BDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2223
Mailing Address - Country:US
Mailing Address - Phone:863-688-4106
Mailing Address - Fax:863-688-5818
Practice Address - Street 1:2945 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2223
Practice Address - Country:US
Practice Address - Phone:863-688-4106
Practice Address - Fax:863-688-5818
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN85071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice