Provider Demographics
NPI:1396408670
Name:FARR, SAMANTHA EVANS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:EVANS
Last Name:FARR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:KAY (REMOVE)
Other - Last Name:EVANS (REMOVE)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:893 N INTERSTATE 35 STE 210
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4311
Mailing Address - Country:US
Mailing Address - Phone:215-255-1900
Mailing Address - Fax:
Practice Address - Street 1:893 N INTERSTATE 35 STE 210
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4311
Practice Address - Country:US
Practice Address - Phone:215-255-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX379331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty