Provider Demographics
NPI:1700362498
Name:FARNSWORTH ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:FARNSWORTH ORTHODONTICS, PLLC
Other - Org Name:FARNSWORTH ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:480-285-4857
Mailing Address - Street 1:701 N CANYON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5817
Mailing Address - Country:US
Mailing Address - Phone:575-887-2444
Mailing Address - Fax:
Practice Address - Street 1:701 N CANYON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-8822
Practice Address - Country:US
Practice Address - Phone:575-887-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM37651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty