Provider Demographics
NPI:1982856027
Name:FARRELL, THERESA KATHERINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:KATHERINE
Last Name:FARRELL
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 1:336 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1717
Mailing Address - Country:US
Mailing Address - Phone:201-594-9991
Mailing Address - Fax:201-594-9981
Practice Address - Street 1:336 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1717
Practice Address - Country:US
Practice Address - Phone:201-594-9991
Practice Address - Fax:201-594-9981
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016861001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice