Active NPI
Katrine Attia Farag, DMD
- General Practice Dentistry
- Lehigh Acres, FL
National Provider Identifier
1487810628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN18366
- Practice address
- 3400 Lee Blvd
Units 101-104
Lehigh Acres, FL 33971-1309 - Phone
- (239) 344-2385
- Fax
- (239) 368-5460
- NPI assigned
- Aug 6, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN18366 | FL | Primary |
Addresses
Primary practice location
3400 Lee Blvd
Units 101-104
Lehigh Acres, FL 33971-1309
Mailing address
PO Box 1357
Fort Myers, FL 33902-1357
Phone (239) 278-3600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000383600 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN18366 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Centers of Southwest Florida Inc | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Fort Myers, FL
- NPI 1326090390
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316131200000",
"number": "1487810628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1357",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339021357",
"telephone_number": "239-278-3600",
"fax_number": "239-278-3203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 LEE BLVD",
"address_2": "UNITS 101-104",
"city": "LEHIGH ACRES",
"state": "FL",
"postal_code": "339711309",
"telephone_number": "239-344-2385",
"fax_number": "239-368-5460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARAG",
"first_name": "KATRINE",
"middle_name": "ATTIA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-06",
"last_updated": "2011-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN18366",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000383600",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lehigh Acres, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.