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General NPI Number Information
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NPI Number | 1376979542
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Entity Type | Organization
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Legal Business Name | FORESTVILLE DENTAL, MICHAEL D. FARMER, D.M.D., INC.
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 7535 STATE ROAD UNITE M
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City | CINCINNATI
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State | OH
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Zip | 45255
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Country | US
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Telephone | 513-231-5444
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Fax | 513-231-8135
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Provider Business Mailing Address
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Address Line | 7535 STATE RD UNIT M
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City | CINCINNATI
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State | OH
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Zip | 45255-2438
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Country | US
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Telephone | 513-231-5444
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Fax | 513-231-8135
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL D FARMER
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Credential | D.M.D.
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Telephone | 513-593-6051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30022669
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License Number State | OH
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