Healthcare Provider Details

I. General information

NPI: 1194416503
Provider Name (Legal Business Name): LUKE FARLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 S 82ND ST # NE68516
LINCOLN NE
68516-6811
US

IV. Provider business mailing address

621 SUNRISE ST
DENVER IA
50622-9588
US

V. Phone/Fax

Practice location:
  • Phone: 531-895-7204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8031
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: