Provider Demographics
NPI:1891887568
Name:FARHA, KENNETH FARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:FARRIS
Last Name:FARHA
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 1:2640 BELL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4375
Mailing Address - Country:US
Mailing Address - Phone:334-260-0501
Mailing Address - Fax:334-260-0502
Practice Address - Street 1:2640 BELL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4375
Practice Address - Country:US
Practice Address - Phone:334-260-0501
Practice Address - Fax:334-260-0502
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68695Medicare UPIN
AL000092046Medicare ID - Type UnspecifiedPROVIDER #