Provider Demographics
NPI:1134297013
Name:FARR, WILLIAM L (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:FARR
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 1:21851 CENTER RIDGE RD STE 506
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3901
Mailing Address - Country:US
Mailing Address - Phone:440-331-3211
Mailing Address - Fax:440-331-3399
Practice Address - Street 1:21851 CENTER RIDGE RD STE 506
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3901
Practice Address - Country:US
Practice Address - Phone:440-331-3211
Practice Address - Fax:440-331-3399
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH195411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341760741OtherTAX ID
OH846191OtherUNITED CONCORDIA PROVIDER
OH341760741001OtherMEDICAL MUTUAL ID