Provider Demographics
NPI:1295265015
Name:FARAH, FADI AMER (DMD)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:AMER
Last Name:FARAH
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1305
Mailing Address - Country:US
Mailing Address - Phone:508-557-2400
Mailing Address - Fax:
Practice Address - Street 1:672 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1306
Practice Address - Country:US
Practice Address - Phone:617-749-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18595921223G0001X
MADA06547126800000X
MADL13612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice
No126800000XDental ProvidersDental Assistant