Provider Demographics
NPI:1700223732
Name:ANNETTE T. FARTHING DDS, PC
Entity Type:Organization
Organization Name:ANNETTE T. FARTHING DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FARTHING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-882-7694
Mailing Address - Street 1:PO BOX 39136
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-0136
Mailing Address - Country:US
Mailing Address - Phone:317-882-7694
Mailing Address - Fax:317-882-8234
Practice Address - Street 1:7725 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8654
Practice Address - Country:US
Practice Address - Phone:317-882-7694
Practice Address - Fax:317-882-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007985A1223P0221X
IN12011645A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100239420Medicaid