Provider Demographics
NPI:1831484732
Name:FARRELL, AMY ELISABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELISABETH
Last Name:FARRELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SHAWNEE GRN
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3635
Mailing Address - Country:US
Mailing Address - Phone:267-481-2053
Mailing Address - Fax:
Practice Address - Street 1:2900 SHAWNEE GRN
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3635
Practice Address - Country:US
Practice Address - Phone:267-481-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0386831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice