Provider Demographics
NPI:1326533209
Name:FARRELL, CHRISTINA WEAVER (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:WEAVER
Last Name:FARRELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ANN
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:BLANDON
Mailing Address - State:PA
Mailing Address - Zip Code:19510
Mailing Address - Country:US
Mailing Address - Phone:610-926-1233
Mailing Address - Fax:610-916-7640
Practice Address - Street 1:109 ANNA AVE
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510
Practice Address - Country:US
Practice Address - Phone:610-926-1233
Practice Address - Fax:610-916-7640
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042101122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036507360001Medicaid