Healthcare Provider Details

I. General information

NPI: 1801583539
Provider Name (Legal Business Name): FARLEY FAMILY DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E RAILROAD ST
LONG BEACH MS
39560-5025
US

IV. Provider business mailing address

902 E RAILROAD ST
LONG BEACH MS
39560-5025
US

V. Phone/Fax

Practice location:
  • Phone: 228-214-3650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHEILA FARLEY
Title or Position: DR.
Credential:
Phone: 228-214-3650