Provider Demographics
NPI:1225692635
Name:DAVID L. FARLEY LLC
Entity Type:Organization
Organization Name:DAVID L. FARLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-243-1451
Mailing Address - Street 1:717 ENCINO PL NE STE 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2622
Mailing Address - Country:US
Mailing Address - Phone:505-243-1451
Mailing Address - Fax:505-243-2772
Practice Address - Street 1:717 ENCINO PL NE STE 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2622
Practice Address - Country:US
Practice Address - Phone:505-243-1451
Practice Address - Fax:505-243-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34WECKD5919Medicaid