Provider Demographics
NPI:1740341999
Name:FAROOKI, TAHIR R (DDS)
Entity type:Individual
Prefix:DR
First Name:TAHIR
Middle Name:R
Last Name:FAROOKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FACTEAU AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6422
Mailing Address - Country:US
Mailing Address - Phone:518-561-5700
Mailing Address - Fax:518-561-5700
Practice Address - Street 1:1785 MILITARY TPKE
Practice Address - Street 2:SUITE # 12
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7704
Practice Address - Country:US
Practice Address - Phone:518-561-5700
Practice Address - Fax:518-561-5700
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0418991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01142763Medicaid