Provider Demographics
NPI:1912040809
Name:FARRAR, ASHLEY L (DDS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:FARRAR
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 1:1509 EMERALD PKWY
Mailing Address - Street 2:STE. 105
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5501
Mailing Address - Country:US
Mailing Address - Phone:979-696-8681
Mailing Address - Fax:
Practice Address - Street 1:1509 EMERALD PKWY
Practice Address - Street 2:STE. 105
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5501
Practice Address - Country:US
Practice Address - Phone:979-696-8681
Practice Address - Fax:979-680-1330
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice