Provider Demographics
NPI:1184737108
Name:MCDOWELL & FARIS, DMD, LLC
Entity type:Organization
Organization Name:MCDOWELL & FARIS, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIORPARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-564-6852
Mailing Address - Street 1:1 W MCDONALD PKWY
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1164
Mailing Address - Country:US
Mailing Address - Phone:606-564-6852
Mailing Address - Fax:606-564-8119
Practice Address - Street 1:1 W MCDONALD PKWY
Practice Address - Street 2:SUITE 2-D
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1164
Practice Address - Country:US
Practice Address - Phone:606-564-6852
Practice Address - Fax:606-564-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1375487OtherBLUE CROSS BLUE SHIELD