Provider Demographics
NPI:1649210162
Name:FARRAR, WILLIAM K JR (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:K
Last Name:FARRAR
Suffix:JR
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 OLD 41 HWY NW
Mailing Address - Street 2:SUITE 112-276
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4480
Mailing Address - Country:US
Mailing Address - Phone:770-778-8210
Mailing Address - Fax:678-401-6263
Practice Address - Street 1:3770 DUE WEST RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1016
Practice Address - Country:US
Practice Address - Phone:770-778-8210
Practice Address - Fax:678-401-6263
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN00069541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics