Provider Demographics
NPI:1396844247
Name:FARRELL, PAUL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:FARRELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1364
Mailing Address - Country:US
Mailing Address - Phone:610-777-7646
Mailing Address - Fax:610-777-7570
Practice Address - Street 1:517 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1364
Practice Address - Country:US
Practice Address - Phone:610-777-7646
Practice Address - Fax:610-777-7570
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022780-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50004504OtherCAPITAL BLUE CROSS
PAFA405924OtherHIGHMARK BLUE SHIELD
PA0009905440002Medicaid
PA9922780OtherDELTA DENTAL OF PA
PA0009905440001Medicaid
PA18605OtherHEALTH AM/HEALTH ASSURANC
PAFA405924OtherHIGHMARK BLUE SHIELD
PA50004504OtherCAPITAL BLUE CROSS