Provider Demographics
NPI:1194734723
Name:FARAG, JOSEPH HALIM (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HALIM
Last Name:FARAG
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 1:3441 CONWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-7002
Mailing Address - Country:US
Mailing Address - Phone:941-764-9555
Mailing Address - Fax:941-764-9277
Practice Address - Street 1:3441 CONWAY BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-7002
Practice Address - Country:US
Practice Address - Phone:941-764-9555
Practice Address - Fax:941-764-9277
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
83855OtherBCBS