Provider Demographics
NPI:1972501104
Name:FARLEY, DARRYL D (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:D
Last Name:FARLEY
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17952 SW BLANTON ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-1329
Mailing Address - Country:US
Mailing Address - Phone:503-649-5665
Mailing Address - Fax:503-649-6857
Practice Address - Street 1:17952 SW BLANTON ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97007-1329
Practice Address - Country:US
Practice Address - Phone:503-649-5665
Practice Address - Fax:503-649-6857
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR52781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice