Provider Demographics
NPI:1366188922
Name:JOHN FARAH PA
Entity type:Organization
Organization Name:JOHN FARAH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-614-0486
Mailing Address - Street 1:55 N CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2204
Mailing Address - Country:US
Mailing Address - Phone:321-269-3802
Mailing Address - Fax:321-269-0920
Practice Address - Street 1:55 N CARPENTER RD
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2204
Practice Address - Country:US
Practice Address - Phone:321-269-3802
Practice Address - Fax:321-269-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1578930707OtherDENTIST PRACTICING AT LOCATION