Provider Demographics
NPI:1982190435
Name:FARLEY, BRIAN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:FARLEY
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 1:1628 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3007
Mailing Address - Country:US
Mailing Address - Phone:304-236-2366
Mailing Address - Fax:304-899-2227
Practice Address - Street 1:1628 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3007
Practice Address - Country:US
Practice Address - Phone:304-236-2366
Practice Address - Fax:304-899-2227
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist