Individual
FAIRY BAXI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
240 S 40TH ST, PHILADELPHIA, PA 19104-6030
(215) 898-8965
Mailing address
5630 PLANK RD, FREDERICKSBURG, VA 22407-6641
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS039019
PA
Other
Enumeration date
06/30/2010
Last updated
02/28/2024
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