Provider Demographics
NPI:1780224915
Name:FARAJ, MOHAAD AMAR
Entity type:Individual
Prefix:
First Name:MOHAAD
Middle Name:AMAR
Last Name:FARAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 63RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5742
Mailing Address - Country:US
Mailing Address - Phone:806-577-8600
Mailing Address - Fax:806-403-3340
Practice Address - Street 1:3233 63RD ST STE A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5742
Practice Address - Country:US
Practice Address - Phone:806-577-8600
Practice Address - Fax:806-403-3340
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12873390200000X
TX394501223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223P0700XDental ProvidersDentistProsthodontics