Provider Demographics
NPI:1932297611
Name:FARR, GREGORY DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DONALD
Last Name:FARR
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 1:4449 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3435
Mailing Address - Country:US
Mailing Address - Phone:972-240-0400
Mailing Address - Fax:972-240-0676
Practice Address - Street 1:4449 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3435
Practice Address - Country:US
Practice Address - Phone:972-240-0400
Practice Address - Fax:972-240-0676
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice