Provider Demographics
NPI:1588232573
Name:FARRIS, EMILY GRACE (DDS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:FARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 NW 120TH TER APT 207
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-0678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13005 SW 1ST RD STE 233
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32669-3266
Practice Address - Country:US
Practice Address - Phone:352-436-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN265951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program