Provider Demographics
NPI:1043737323
Name:FARR, BRYANT CAMERON (DMD)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:CAMERON
Last Name:FARR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 ROCKY RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2615
Mailing Address - Country:US
Mailing Address - Phone:480-650-3905
Mailing Address - Fax:
Practice Address - Street 1:39033 SUPPORT AVE.
Practice Address - Street 2:
Practice Address - City:FT. HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist