Provider Demographics
NPI:1811043292
Name:KATHY J FARLEY DDS PA
Entity Type:Organization
Organization Name:KATHY J FARLEY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-224-1105
Mailing Address - Street 1:600 RIDGELY AVE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8804
Mailing Address - Country:US
Mailing Address - Phone:410-224-1105
Mailing Address - Fax:410-224-1108
Practice Address - Street 1:600 RIDGELY AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-8804
Practice Address - Country:US
Practice Address - Phone:410-224-1105
Practice Address - Fax:410-224-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty