Healthcare Provider Details

I. General information

NPI: 1790813293
Provider Name (Legal Business Name): WILLIAM REUEL FARNSWORTH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W VIRGINIA ST
EVANSVILLE IN
47710-1614
US

IV. Provider business mailing address

550 W VIRGINIA ST
EVANSVILLE IN
47710-1684
US

V. Phone/Fax

Practice location:
  • Phone: 812-425-5194
  • Fax: 812-426-9984
Mailing address:
  • Phone: 812-425-5194
  • Fax: 812-426-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS 42
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: