Provider Demographics
NPI:1336301076
Name:JEFFERY FARMER, D.D.S., P.C.
Entity Type:Organization
Organization Name:JEFFERY FARMER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:615-895-3232
Mailing Address - Street 1:1535 W NORTHFIELD BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1427
Mailing Address - Country:US
Mailing Address - Phone:615-895-3232
Mailing Address - Fax:615-893-3224
Practice Address - Street 1:1535 W NORTHFIELD BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1427
Practice Address - Country:US
Practice Address - Phone:615-895-3232
Practice Address - Fax:615-893-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4150261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0004776Medicaid