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General NPI Number Information
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NPI Number | 1487096640
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Entity Type | Organization
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Legal Business Name | MARK M FARTHING DDS
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 8602 E 10TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-5443
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Country | US
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Telephone | 317-898-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 8602 E 10TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-5443
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK FARTHING
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Credential | DDS
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Telephone | 317-898-3384
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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 | 12008383A
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License Number State | IN
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