Provider Demographics
NPI:1346468469
Name:FARABEE, ERNEST CECIL III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:CECIL
Last Name:FARABEE
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1246 KELLIWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7849
Mailing Address - Country:US
Mailing Address - Phone:318-798-2521
Mailing Address - Fax:
Practice Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 112
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3132
Practice Address - Country:US
Practice Address - Phone:318-688-2225
Practice Address - Fax:318-688-2306
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics