Provider Demographics
NPI:1992205801
Name:SETH T FARREN DDS ORAL AND MAXILLOFACIAL SURGERY PLLC
Entity Type:Organization
Organization Name:SETH T FARREN DDS ORAL AND MAXILLOFACIAL SURGERY PLLC
Other - Org Name:GREAT OAK ORAL SURGERY AND DENTAL IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:FARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-682-6400
Mailing Address - Street 1:100 GREAT OAKS BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-7924
Mailing Address - Country:US
Mailing Address - Phone:518-682-6400
Mailing Address - Fax:518-682-6402
Practice Address - Street 1:100 GREAT OAKS BLVD STE 112
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-7924
Practice Address - Country:US
Practice Address - Phone:518-682-6400
Practice Address - Fax:518-682-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery