Provider Demographics
NPI:1841406089
Name:FARAHAY FAMILY DENTAL CARE, INC
Entity Type:Organization
Organization Name:FARAHAY FAMILY DENTAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:Q
Authorized Official - Last Name:FARAHAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-439-1204
Mailing Address - Street 1:522 WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725
Mailing Address - Country:US
Mailing Address - Phone:740-439-1204
Mailing Address - Fax:740-439-9392
Practice Address - Street 1:522 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725
Practice Address - Country:US
Practice Address - Phone:740-439-1204
Practice Address - Fax:740-439-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH218961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2663676Medicaid
1879409OtherUNITED CONCORDIA