Provider Demographics
NPI:1841382728
Name:FARRAR, EDWIN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:LEE
Last Name:FARRAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1500
Mailing Address - Country:US
Mailing Address - Phone:419-756-0711
Mailing Address - Fax:419-756-4886
Practice Address - Street 1:630 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1500
Practice Address - Country:US
Practice Address - Phone:419-756-0711
Practice Address - Fax:419-756-4886
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGA9279161Medicaid
OHGA9279161Medicaid
OHFA0532702Medicare PIN