Healthcare Provider Details

I. General information

NPI: 1861585531
Provider Name (Legal Business Name): AMY B. FARNSWORTH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7206 DIXIE HWY.
LOUISVILLE KY
40258
US

IV. Provider business mailing address

7206 DIXIE HWY.
LOUISVILLE KY
40258
US

V. Phone/Fax

Practice location:
  • Phone: 502-933-2323
  • Fax: 502-933-2332
Mailing address:
  • Phone: 502-933-2323
  • Fax: 502-933-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6684
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: