Provider Demographics
NPI:1164523627
Name:FARNHAM, BRETT THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:THOMAS
Last Name:FARNHAM
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 1:2110 N MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-5524
Mailing Address - Country:US
Mailing Address - Phone:605-996-9944
Mailing Address - Fax:605-996-3426
Practice Address - Street 1:2110 N MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-5524
Practice Address - Country:US
Practice Address - Phone:605-996-9944
Practice Address - Fax:605-996-3426
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM7951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice