Provider Demographics
NPI:1871806695
Name:AYMAN K FARAH, DDS, PS
Entity type:Organization
Organization Name:AYMAN K FARAH, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-335-8899
Mailing Address - Street 1:3307 EVERGREEN WAY STE 706
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2065
Mailing Address - Country:US
Mailing Address - Phone:360-335-8899
Mailing Address - Fax:
Practice Address - Street 1:3307 EVERGREEN WAY STE 706
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2065
Practice Address - Country:US
Practice Address - Phone:360-335-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA75501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1679606115OtherINDIVIDUAL NPI