Provider Demographics
NPI:1750034617
Name:FARBER, SHAWNA M (RDH)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:FARBER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:DIGHTON
Mailing Address - State:KS
Mailing Address - Zip Code:67839-0753
Mailing Address - Country:US
Mailing Address - Phone:620-214-2191
Mailing Address - Fax:
Practice Address - Street 1:545 SOUTH CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DIGHTON
Practice Address - State:KS
Practice Address - Zip Code:67839
Practice Address - Country:US
Practice Address - Phone:620-214-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11216124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty