Healthcare Provider Details

I. General information

NPI: 1649472184
Provider Name (Legal Business Name): JAMES ROMAN FARRAR D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 NORTHPOINTE LN STE 104
RUSTON LA
71270-3853
US

IV. Provider business mailing address

PO BOX 190
RUSTON LA
71273-0190
US

V. Phone/Fax

Practice location:
  • Phone: 318-548-4334
  • Fax:
Mailing address:
  • Phone: 318-255-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5241
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: