Provider Demographics
NPI:1801813753
Name:FAREED, GHULAM
Entity Type:Individual
Prefix:
First Name:GHULAM
Middle Name:
Last Name:FAREED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 GOVERNORS HILL
Mailing Address - Street 2:#105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249
Mailing Address - Country:US
Mailing Address - Phone:513-697-2640
Mailing Address - Fax:513-697-2650
Practice Address - Street 1:300 E KEMPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246
Practice Address - Country:US
Practice Address - Phone:513-671-6161
Practice Address - Fax:513-697-2650
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH214411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice