Provider Demographics
NPI:1689787236
Name:HART, FARYL KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARYL
Middle Name:KAY
Last Name:HART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 E PARHAM RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2235
Mailing Address - Country:US
Mailing Address - Phone:804-266-2074
Mailing Address - Fax:804-266-2099
Practice Address - Street 1:2103 E PARHAM RD STE 102
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2235
Practice Address - Country:US
Practice Address - Phone:804-266-2074
Practice Address - Fax:804-266-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist