Provider Demographics
NPI:1730604117
Name:NASSER, FARAH AHMAD (DDS)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:AHMAD
Last Name:NASSER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18947 VAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4703
Mailing Address - Country:US
Mailing Address - Phone:248-802-5109
Mailing Address - Fax:
Practice Address - Street 1:14639 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3173
Practice Address - Country:US
Practice Address - Phone:313-582-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010222581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice