MEDICARE: DR. BRUCE EDWARD FARRELL DDS

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	122300000X	Dentist	43003	CA

General Provider Information

NPI Number	:	1811082167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE EDWARD FARRELL DDS

Provider Business Mailing Address
First Line	:	9348 DESCHUTES RD STE A
Second Line	:
City	:	PALO CEDRO
State	:	CA
Zip	:	96073-8730
Country	:	US
Telephone Number	:	530-547-5744
Fax Number	:	530-547-5791

Provider Business Practice Location Address
First Line	:	9336 DESCHUTES RD
Second Line	:
City	:	PALO CEDRO
State	:	CA
Zip	:	96073-9763
Country	:	US
Telephone Number	:	530-547-5744
Fax Number	:	530-547-5791

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/07/2018

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