Healthcare Provider Details

I. General information

NPI: 1013835776
Provider Name (Legal Business Name): C KEVIN FARR, DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 EL CAMINO REAL
ATASCADERO CA
93422-3355
US

IV. Provider business mailing address

5425 EL CAMINO REAL
ATASCADERO CA
93422-3355
US

V. Phone/Fax

Practice location:
  • Phone: 805-432-0977
  • Fax: 805-461-3448
Mailing address:
  • Phone: 805-432-0977
  • Fax: 805-461-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES KEVIN FARR
Title or Position: PRESIDENT/CEO
Credential: DMD
Phone: 805-423-0977