Provider Demographics
NPI:1073688537
Name:OFARRILL, ANA R (DMD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:R
Last Name:OFARRILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743
Mailing Address - Country:US
Mailing Address - Phone:407-344-1550
Mailing Address - Fax:407-344-0844
Practice Address - Street 1:1031 PLAZA DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743
Practice Address - Country:US
Practice Address - Phone:407-344-1550
Practice Address - Fax:407-344-0844
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 142101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice