Provider Demographics
NPI:1740265800
Name:FARHA, VINCENT THOMAS (DDS PA)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:THOMAS
Last Name:FARHA
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NORTH GEORGIE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1707
Mailing Address - Country:US
Mailing Address - Phone:316-788-2306
Mailing Address - Fax:316-788-2807
Practice Address - Street 1:500 NORTH GEORGIE AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1707
Practice Address - Country:US
Practice Address - Phone:316-788-2306
Practice Address - Fax:316-788-2807
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS66051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice