Provider Demographics
NPI:1184056046
Name:ALI, FAREHA (DDS)
Entity type:Individual
Prefix:DR
First Name:FAREHA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LIBRARY PARK DR STE B-1
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1562
Mailing Address - Country:US
Mailing Address - Phone:317-881-2050
Mailing Address - Fax:317-885-7485
Practice Address - Street 1:601 LIBRARY PARK DR STE B-1
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1562
Practice Address - Country:US
Practice Address - Phone:317-881-2050
Practice Address - Fax:317-885-7485
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012020A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist