Healthcare Provider Details

I. General information

NPI: 1912046780
Provider Name (Legal Business Name): JOHN EDWARD FARNIE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 CAPITAL OF TEXAS HWY SO ST 109
AUSTIN TX
78704-7927
US

IV. Provider business mailing address

2209 CYPRESS POINT EAST
AUSTIN TX
78746-7222
US

V. Phone/Fax

Practice location:
  • Phone: 512-445-5866
  • Fax: 512-445-4262
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number007037
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: