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General NPI Number Information
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NPI Number | 1700946241
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Entity Type | Individual
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Provider Name | MARK D FARLEY DMD ORTHODONTIST
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1809 ALEXANDRIA PIKE SUITE B
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City | HIGHLAND HEIGHTS
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State | KY
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Zip | 41076
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Country | US
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Telephone | 859-441-7900
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Fax | 859-441-5025
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Provider Business Mailing Address
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Address Line | 80 SOUTH SHAW LANE
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City | FT THOMAS
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State | KY
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Zip | 41075
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Country | US
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Telephone | 859-441-1487
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | KY5670
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License Number State | KY
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