MEDICARE: MARK D FARLEY DMD ORTHODONTIST

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	KY5670	KY

General Provider Information

NPI Number	:	1700946241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK D FARLEY DMD ORTHODONTIST

Provider Business Mailing Address
First Line	:	80 SOUTH SHAW LANE
Second Line	:
City	:	FT THOMAS
State	:	KY
Zip	:	41075
Country	:	US
Telephone Number	:	859-441-1487
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 ALEXANDRIA PIKE
Second Line	:	SUITE B
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076
Country	:	US
Telephone Number	:	859-441-7900
Fax Number	:	859-441-5025

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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