Provider Demographics
NPI:1346667243
Name:FARR WEST ORTHODONTICS
Entity Type:Organization
Organization Name:FARR WEST ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:801-731-4850
Mailing Address - Street 1:1761 N 2000 W
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9541
Mailing Address - Country:US
Mailing Address - Phone:801-731-4850
Mailing Address - Fax:
Practice Address - Street 1:1761 N 2000 W
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9541
Practice Address - Country:US
Practice Address - Phone:801-731-4850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8718587-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty