Healthcare Provider Details

I. General information

NPI: 1225150378
Provider Name (Legal Business Name): JENNIFER R FARRELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 YALE BLVD NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

900 YALE BLVD NE
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 773-456-5226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40135
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDB2025-0486
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019023442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: