Provider Demographics
NPI:1972295103
Name:FARMER, ALYSSA CLAIRE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:CLAIRE
Last Name:FARMER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 CHAMBERS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2573
Mailing Address - Country:US
Mailing Address - Phone:502-348-2777
Mailing Address - Fax:
Practice Address - Street 1:919 CHAMBERS BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2573
Practice Address - Country:US
Practice Address - Phone:502-348-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY109411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice