Provider Demographics
NPI:1326140872
Name:FARIS, GEOFFREY KIRK (DMD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:KIRK
Last Name:FARIS
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 1:2031 HAWTHORNE ST STE B
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1700
Mailing Address - Country:US
Mailing Address - Phone:503-359-4463
Mailing Address - Fax:503-359-1328
Practice Address - Street 1:2031 HAWTHORNE ST STE B
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1700
Practice Address - Country:US
Practice Address - Phone:503-359-4463
Practice Address - Fax:503-359-1328
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD63451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice