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General NPI Number Information
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NPI Number | 1184047961
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Entity Type | Organization
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Legal Business Name | FARMINGTON FAMILY DENTISTRY L.L.C.
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 703 N DUSTIN AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-6101
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Country | US
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Telephone | 505-564-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 703 N DUSTIN AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-6101
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Country | US
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Telephone | 505-564-9700
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Fax |
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Authorized Official
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Title or Position | DENTIST/MANAGING PARTNER
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Name | DR. DANIEL J FARLEY
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Credential | D.D.S.
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Telephone | 505-564-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD1297
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License Number State | NM
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