Provider Demographics
NPI:1104056621
Name:ILYAS, FARAH (DDS)
Entity type:Individual
Prefix:DR
First Name:FARAH
Middle Name:
Last Name:ILYAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13518 MITCHELLS WAY
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-9405
Mailing Address - Country:US
Mailing Address - Phone:443-745-0442
Mailing Address - Fax:
Practice Address - Street 1:250 ENGLAR RD STE 6
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-2927
Practice Address - Country:US
Practice Address - Phone:410-848-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice