Provider Demographics
NPI:1942623475
Name:FARLEY DENTAL CARE LLC
Entity type:Organization
Organization Name:FARLEY DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-377-2219
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-0512
Mailing Address - Country:US
Mailing Address - Phone:740-377-2219
Mailing Address - Fax:740-377-4987
Practice Address - Street 1:301 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-9635
Practice Address - Country:US
Practice Address - Phone:740-377-2219
Practice Address - Fax:740-377-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2943668Medicaid