Individual
MUKTAR FARAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
115 BROADWAY ST NE, MINNEAPOLIS, MN 55413-1805
(612) 326-1300
Mailing address
115 BROADWAY ST NE, MINNEAPOLIS, MN 55413-1805
(612) 326-1300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14215
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D14215
—
MN
Enumeration date
05/20/2019
Last updated
05/20/2019
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