Provider Demographics
NPI:1790735538
Name:FARRELL, DONALD B (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:FARRELL
Suffix:
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 1:1512 BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:ME
Mailing Address - Zip Code:04901-3323
Mailing Address - Country:US
Mailing Address - Phone:207-453-2977
Mailing Address - Fax:
Practice Address - Street 1:1512 BENTON AVE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:ME
Practice Address - Zip Code:04901-3323
Practice Address - Country:US
Practice Address - Phone:207-453-2977
Practice Address - Fax:207-453-9945
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME31871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice