Provider Demographics
NPI:1760912877
Name:FARR, KEVIN KIMBALL JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KIMBALL
Last Name:FARR
Suffix:JR
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 1:159 ALTAMA CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1853
Mailing Address - Country:US
Mailing Address - Phone:912-264-8408
Mailing Address - Fax:
Practice Address - Street 1:159 ALTAMA CONNECTOR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1853
Practice Address - Country:US
Practice Address - Phone:912-264-8408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0154381223G0001X
KY102151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice