Provider Demographics
NPI:1124229042
Name:FARLEY, ROGER LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LYNN
Last Name:FARLEY
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 1:390 W 920 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3042
Mailing Address - Country:US
Mailing Address - Phone:801-225-0471
Mailing Address - Fax:801-225-4461
Practice Address - Street 1:390 W 920 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3042
Practice Address - Country:US
Practice Address - Phone:801-225-0471
Practice Address - Fax:801-225-4461
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13712299221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice