Provider Demographics
NPI:1013880798
Name:FARROUKH, KHALIFA SADY (DDS)
Entity type:Individual
Prefix:
First Name:KHALIFA
Middle Name:SADY
Last Name:FARROUKH
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 1:1715 BORBECK AVE FL AE2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3514
Mailing Address - Country:US
Mailing Address - Phone:215-554-5155
Mailing Address - Fax:
Practice Address - Street 1:1715 BORBECK AVE FL AE2
Practice Address - Street 2:2ND FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3514
Practice Address - Country:US
Practice Address - Phone:215-554-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1123941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice