Provider Demographics
NPI:1922484781
Name:MARY F. FARREN, DMD, LLC
Entity Type:Organization
Organization Name:MARY F. FARREN, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-751-6606
Mailing Address - Street 1:1908 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2004
Mailing Address - Country:US
Mailing Address - Phone:856-751-6606
Mailing Address - Fax:856-751-6607
Practice Address - Street 1:1908 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2004
Practice Address - Country:US
Practice Address - Phone:856-751-6606
Practice Address - Fax:856-751-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02035100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1043228877OtherINDIVIDUAL NPI