MEDICARE: DR. JAMES ROMAN FARRAR D.D.S

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	1223E0200X	Endodontics	5241	LA

General Provider Information

NPI Number	:	1649472184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ROMAN FARRAR D.D.S

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71273-0190
Country	:	US
Telephone Number	:	318-255-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 NORTHPOINTE LN
Second Line	:	STE 104
City	:	RUSTON
State	:	LA
Zip	:	71270-3853
Country	:	US
Telephone Number	:	318-548-4334
Fax Number	:

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/01/2013

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