Provider Demographics
NPI:1790100451
Name:AMY T FARRAR DDS PLLC
Entity Type:Organization
Organization Name:AMY T FARRAR DDS PLLC
Other - Org Name:FARRAR FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-973-5696
Mailing Address - Street 1:7010 NC HIGHWAY 751 STE 103
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5734
Mailing Address - Country:US
Mailing Address - Phone:919-973-5696
Mailing Address - Fax:
Practice Address - Street 1:7010 NC HIGHWAY 751
Practice Address - Street 2:SUITE 103
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5500
Practice Address - Country:US
Practice Address - Phone:919-973-5696
Practice Address - Fax:919-973-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911016Medicaid