MEDICARE: DR. DONALD B FARRELL D.M.D.

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	3187	ME

General Provider Information

NPI Number	:	1790735538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD B FARRELL D.M.D.

Provider Business Mailing Address
First Line	:	1512 BENTON AVE
Second Line	:
City	:	BENTON
State	:	ME
Zip	:	04901-3323
Country	:	US
Telephone Number	:	207-453-2977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 BENTON AVE
Second Line	:
City	:	BENTON
State	:	ME
Zip	:	04901-3323
Country	:	US
Telephone Number	:	207-453-2977
Fax Number	:	207-453-9945

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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