Provider Demographics
NPI:1215903364
Name:FARAHAY, KIMBERLY Q (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:Q
Last Name:FARAHAY
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 1:522 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
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH218961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1879409OtherUNITED CONCORDIA PROVIDER
OH2663676Medicaid