Provider Demographics
NPI:1396095824
Name:COREY S. FARBER, PLLC
Entity type:Organization
Organization Name:COREY S. FARBER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-562-5611
Mailing Address - Street 1:23919 FORD ROAD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128
Mailing Address - Country:US
Mailing Address - Phone:313-562-5611
Mailing Address - Fax:313-562-1507
Practice Address - Street 1:23919 FORD ROAD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128
Practice Address - Country:US
Practice Address - Phone:313-562-5611
Practice Address - Fax:313-562-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty