Provider Demographics
NPI:1598903122
Name:EVAN FARR D.D.S INC
Entity Type:Organization
Organization Name:EVAN FARR D.D.S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EAVN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-521-4049
Mailing Address - Street 1:23705 VANOWEN ST # 308
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3030
Mailing Address - Country:US
Mailing Address - Phone:818-521-4049
Mailing Address - Fax:
Practice Address - Street 1:12115 SATICOY ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3025
Practice Address - Country:US
Practice Address - Phone:818-759-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty