Provider Demographics
NPI:1770349425
Name:FARHA, PHILIPPE (DMD)
Entity type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:
Last Name:FARHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 HARRISON AVE APT 837
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3080
Mailing Address - Country:US
Mailing Address - Phone:410-710-7384
Mailing Address - Fax:
Practice Address - Street 1:345 HARRISON AVE APT 837
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3080
Practice Address - Country:US
Practice Address - Phone:410-710-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN100005181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program