Healthcare Provider Details

I. General information

NPI: 1780776575
Provider Name (Legal Business Name): EDWIN L FARRAR, DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 LEXINGTON AVE
MANSFIELD OH
44907-1500
US

IV. Provider business mailing address

630 LEXINGTON AVE
MANSFIELD OH
44907-1500
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-0711
  • Fax: 419-756-4886
Mailing address:
  • Phone: 419-756-0711
  • Fax: 419-756-4886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MRS. RANDI PATRICIA BITTLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-756-0711