Provider Demographics
NPI:1972227726
Name:JACOB R. FARMER, DDS, PLLC
Entity Type:Organization
Organization Name:JACOB R. FARMER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-514-9212
Mailing Address - Street 1:4305 NE THURSTON WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6655
Mailing Address - Country:US
Mailing Address - Phone:360-514-9212
Mailing Address - Fax:
Practice Address - Street 1:4305 NE THURSTON WAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6655
Practice Address - Country:US
Practice Address - Phone:360-514-9212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental