Provider Demographics
NPI:1326356056
Name:FARRIMOND, ELIZABETH MARYLL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARYLL
Last Name:FARRIMOND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6253 VANCE JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3347
Mailing Address - Country:US
Mailing Address - Phone:210-690-4500
Mailing Address - Fax:210-690-5835
Practice Address - Street 1:6253 VANCE JACKSON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3347
Practice Address - Country:US
Practice Address - Phone:210-690-4500
Practice Address - Fax:210-690-5835
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist