Provider Demographics
NPI:1942653969
Name:FARR, RILEY
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:FARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-7827
Mailing Address - Country:US
Mailing Address - Phone:918-333-4500
Mailing Address - Fax:
Practice Address - Street 1:5401 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7827
Practice Address - Country:US
Practice Address - Phone:918-333-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist