Healthcare Provider Details

I. General information

NPI: 1104893056
Provider Name (Legal Business Name): BARRY J FARMER, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N YORK ST
MUSKOGEE OK
74403-3863
US

IV. Provider business mailing address

806 N YORK ST
MUSKOGEE OK
74403-3863
US

V. Phone/Fax

Practice location:
  • Phone: 918-683-3451
  • Fax: 918-683-1116
Mailing address:
  • Phone: 918-683-3451
  • Fax: 918-683-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3385
License Number StateOK

VIII. Authorized Official

Name: DR. BARRY FARMER
Title or Position: PRESIDENT
Credential: DDS
Phone: 918-683-3451