Provider Demographics
NPI:1538411343
Name:DAVID FARNSWORTH ORTHODONTICS PC
Entity type:Organization
Organization Name:DAVID FARNSWORTH ORTHODONTICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:575-762-4794
Mailing Address - Street 1:901 E 21ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4400
Mailing Address - Country:US
Mailing Address - Phone:575-762-4794
Mailing Address - Fax:
Practice Address - Street 1:901 E 21ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4400
Practice Address - Country:US
Practice Address - Phone:575-762-4794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty