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General NPI Number Information
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NPI Number | 1891127221
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Entity Type | Organization
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Legal Business Name | FARWELL DENTAL CLINIC
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 303 3RD ST
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City | FARWELL
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State | TX
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Zip | 79325-4669
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Country | US
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Telephone | 806-481-3336
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Fax | 806-481-3339
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Provider Business Mailing Address
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Address Line | PO BOX 800
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City | FARWELL
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State | TX
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Zip | 79325-0800
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Country | US
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Telephone | 806-481-3336
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Fax | 806-481-3339
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOYCE ROE IVINS JR.
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Credential | D.D.S.
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Telephone | 806-481-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 11608
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License Number State | TX
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