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General NPI Number Information
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NPI Number | 1538737200
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Entity Type | Organization
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Legal Business Name | JEAN L FARBOD DDS PLC
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 125 N PANSY ST
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City | ISHPEMING
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State | MI
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Zip | 49849-3015
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Country | US
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Telephone | 906-485-5575
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Fax |
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Provider Business Mailing Address
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Address Line | 1777 STATE HIGHWAY M28 E
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City | MARQUETTE
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State | MI
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Zip | 49855-9525
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Country | US
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Telephone | 906-236-0147
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEAN FARBOD
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Credential | DDS
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Telephone | 906-236-0147
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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