Provider Demographics
NPI:1033311733
Name:FARRELL, BRENDAN TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:TIMOTHY
Last Name:FARRELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1359
Mailing Address - Country:US
Mailing Address - Phone:785-843-5490
Mailing Address - Fax:
Practice Address - Street 1:308 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1359
Practice Address - Country:US
Practice Address - Phone:785-843-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS607891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery