MEDICARE: DR. DREW D FARMER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8124	SC

General Provider Information

NPI Number	:	1093152670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DREW D FARMER DMD

Provider Business Mailing Address
First Line	:	4323 HILL STREET
Second Line	:	USA DENTAL ACTIVITY
City	:	FORT JACKSON
State	:	SC
Zip	:	29207-6022
Country	:	US
Telephone Number	:	803-751-6213
Fax Number	:

Provider Business Practice Location Address
First Line	:	4323 HILL STREET
Second Line	:	USA DENTAL ACTIVITY
City	:	FORT JACKSON
State	:	SC
Zip	:	29207-6022
Country	:	US
Telephone Number	:	803-751-6213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	05/23/2013

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