Provider Demographics
NPI:1588643985
Name:FARRIS, MARK STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:FARRIS
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 1:1103 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-3528
Mailing Address - Country:US
Mailing Address - Phone:828-659-7323
Mailing Address - Fax:828-655-1905
Practice Address - Street 1:1103 E COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-3528
Practice Address - Country:US
Practice Address - Phone:828-659-7323
Practice Address - Fax:828-655-1905
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC5490122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013T0OtherMEDICAID GROUP #
NC031T0OtherBCBS GROUP #
NC90110OtherBCBS IND. #
NC8990110Medicaid