Provider Demographics
NPI:1518059740
Name:FARNI, COUTLAND TRAVIS (DMD)
Entity Type:Individual
Prefix:MR
First Name:COUTLAND
Middle Name:TRAVIS
Last Name:FARNI
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 1:1064 INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3720
Mailing Address - Country:US
Mailing Address - Phone:251-675-4313
Mailing Address - Fax:251-675-4355
Practice Address - Street 1:1064 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3720
Practice Address - Country:US
Practice Address - Phone:251-675-4313
Practice Address - Fax:251-675-4355
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice