Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS042402 | PA |
NPI | 1003462169 |
---|---|
Provider Name | Nada Farag |
First Address | Bryn Mawr, PA 19010 |
Second Address | Bryn Mawr, PA 19010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 14/08/2019 |