Provider Demographics
NPI:1932729332
Name:FARAHAT, ANDREW MAGDY (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MAGDY
Last Name:FARAHAT
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 1:10907 MOORHEAD CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2710
Mailing Address - Country:US
Mailing Address - Phone:302-379-1497
Mailing Address - Fax:
Practice Address - Street 1:7926 W HILLSBOROUGH AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4600
Practice Address - Country:US
Practice Address - Phone:302-379-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN257851223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice