Provider Demographics
NPI:1508957523
Name:FARROW, WILLIAM J (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:FARROW
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 1:233 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-2500
Mailing Address - Country:US
Mailing Address - Phone:920-766-9542
Mailing Address - Fax:920-759-4439
Practice Address - Street 1:233 DODGE ST
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2500
Practice Address - Country:US
Practice Address - Phone:920-766-9542
Practice Address - Fax:920-759-4439
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50019870151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33383300Medicaid