Provider Demographics
NPI:1497045694
Name:FARLEY, NATHANIAL EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIAL
Middle Name:EDWARD
Last Name:FARLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 S VAL VISTA DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5667
Mailing Address - Country:US
Mailing Address - Phone:480-832-1375
Mailing Address - Fax:
Practice Address - Street 1:1056 S VAL VISTA DR STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5667
Practice Address - Country:US
Practice Address - Phone:480-832-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.27441223P0700X
WI67581223P0700X
AZD0099761223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics