Provider Demographics
NPI:1376365239
Name:FADI FARAH DMD PC
Entity type:Organization
Organization Name:FADI FARAH DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-557-2400
Mailing Address - Street 1:672 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1306
Mailing Address - Country:US
Mailing Address - Phone:508-791-6140
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:508-791-6140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental