Healthcare Provider Details

I. General information

NPI: 1205048816
Provider Name (Legal Business Name): WILLIAM L FARRELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9461 DESCHUTES RD STE 2
PALO CEDRO CA
96073-9761
US

IV. Provider business mailing address

9461 DESCHUTES RD STE 2
PALO CEDRO CA
96073-9761
US

V. Phone/Fax

Practice location:
  • Phone: 530-547-5757
  • Fax: 530-547-5755
Mailing address:
  • Phone: 530-547-5757
  • Fax: 530-547-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: