Provider Demographics
NPI:1578745105
Name:FARMER, DALE LEROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:LEROY
Last Name:FARMER
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 1:1601 S FEDERAL BLVD
Mailing Address - Street 2:#201
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-4872
Mailing Address - Country:US
Mailing Address - Phone:303-934-0232
Mailing Address - Fax:303-934-2208
Practice Address - Street 1:1601 S FEDERAL BLVD
Practice Address - Street 2:#201
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-4872
Practice Address - Country:US
Practice Address - Phone:303-934-0232
Practice Address - Fax:303-934-2208
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist