Provider Demographics
NPI:1538737200
Name:JEAN L FARBOD DDS PLC
Entity type:Organization
Organization Name:JEAN L FARBOD DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:906-236-0147
Mailing Address - Street 1:1777 STATE HIGHWAY M28 E
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9525
Mailing Address - Country:US
Mailing Address - Phone:906-236-0147
Mailing Address - Fax:
Practice Address - Street 1:125 N PANSY ST
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-3015
Practice Address - Country:US
Practice Address - Phone:906-485-5575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty