Provider Demographics
NPI:1679733547
Name:FARRIOR, OLIN FIELDS JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLIN
Middle Name:FIELDS
Last Name:FARRIOR
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 STEVENS AVE
Mailing Address - Street 2:221
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2670
Mailing Address - Country:US
Mailing Address - Phone:207-221-4722
Mailing Address - Fax:207-523-1915
Practice Address - Street 1:716 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2670
Practice Address - Country:US
Practice Address - Phone:207-221-4722
Practice Address - Fax:207-523-1915
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013731122300000X
MEDEN43621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist