Provider Demographics
NPI:1891874830
Name:FARLEY, FOREST MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:FOREST
Middle Name:MICHAEL
Last Name:FARLEY
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 1:1941 BONAIR DR SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-1885
Mailing Address - Country:US
Mailing Address - Phone:206-935-2703
Mailing Address - Fax:253-838-9175
Practice Address - Street 1:1825 S 324TH PL
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8505
Practice Address - Country:US
Practice Address - Phone:253-838-2018
Practice Address - Fax:253-838-9175
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice