MEDICARE: DR. STANLEY JOE FARNUM D.D.S.

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	1617	AZ

General Provider Information

NPI Number	:	1376792051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY JOE FARNUM D.D.S.

Provider Business Mailing Address
First Line	:	6119 E. GRANT RD.
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-721-7874
Fax Number	:	520-721-7876

Provider Business Practice Location Address
First Line	:	6119 E. GRANT RD.
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-721-7874
Fax Number	:	520-721-7876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/17/2008

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