Provider Demographics
NPI:1689736977
Name:MCFARLAND, JACK BRENT (DMD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:BRENT
Last Name:MCFARLAND
Suffix:
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 1:1609 W MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1362
Mailing Address - Country:US
Mailing Address - Phone:334-793-6060
Mailing Address - Fax:334-836-0199
Practice Address - Street 1:1609 W MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1362
Practice Address - Country:US
Practice Address - Phone:334-793-6060
Practice Address - Fax:334-836-0199
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics