MEDICARE: FARWELL DENTAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1154198273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARWELL DENTAL, PLLC

Provider Business Mailing Address
First Line	:	2525 E WHIPPOORWILL HOLW
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48642-7876
Country	:	US
Telephone Number	:	989-280-8066
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 W MAIN ST
Second Line	:
City	:	FARWELL
State	:	MI
Zip	:	48622-8753
Country	:	US
Telephone Number	:	989-588-4121
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. ELIZABETH WINEGAR
Credential	:	DDS
Telephone Number	:	989-280-8066

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	12/08/2023

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