Individual
FARAH ETIBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
23225 NORTHWESTERN HWY, SOUTHFIELD, MI 48075-7707
(248) 965-8707
Mailing address
7092 BEVERLY CREST DR, WEST BLOOMFIELD, MI 48322-3739
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901602049
MI
Other
Enumeration date
08/05/2024
Last updated
08/06/2024
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