Provider Demographics
NPI:1003300435
Name:FARMER, VEENA GOSAI (DMD)
Entity type:Individual
Prefix:DR
First Name:VEENA
Middle Name:GOSAI
Last Name:FARMER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VEENA
Other - Middle Name:MANHAR
Other - Last Name:GOSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:339 BELVEDERE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-6919
Mailing Address - Country:US
Mailing Address - Phone:904-599-4995
Mailing Address - Fax:
Practice Address - Street 1:1701 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6005
Practice Address - Country:US
Practice Address - Phone:910-346-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23506122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist