Provider Demographics
NPI:1477605376
Name:FARSTER - LYEW, JILL ANN (DDS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:FARSTER - LYEW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:FARSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3060 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5526
Mailing Address - Country:US
Mailing Address - Phone:678-344-5511
Mailing Address - Fax:678-344-5577
Practice Address - Street 1:3060 RIVER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5526
Practice Address - Country:US
Practice Address - Phone:678-344-5511
Practice Address - Fax:678-344-5577
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry