Provider Demographics
NPI:1922490010
Name:FARR, MITCHELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:FARR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17971 BISCAYNE BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2578
Mailing Address - Country:US
Mailing Address - Phone:305-931-5252
Mailing Address - Fax:305-931-5835
Practice Address - Street 1:17971 BISCAYNE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2578
Practice Address - Country:US
Practice Address - Phone:305-931-5252
Practice Address - Fax:305-931-5835
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN112551223P0300X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223P0700XDental ProvidersDentistProsthodontics