Provider Demographics
NPI:1891212783
Name:FARMER, AUSTIN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:P
Last Name:FARMER
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 1:2828 WOODSIDE ST APT 3111
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3090
Mailing Address - Country:US
Mailing Address - Phone:806-787-8190
Mailing Address - Fax:
Practice Address - Street 1:1039 E INTERSTATE 30 STE 107
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4912
Practice Address - Country:US
Practice Address - Phone:972-722-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010224191223G0001X
TX346701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34670OtherTSBDE LICENSURE