Provider Demographics
NPI:1255549200
Name:FARLEY, STEPHEN WILSON (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WILSON
Last Name:FARLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 LEXINGTON RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1798
Mailing Address - Country:US
Mailing Address - Phone:859-873-7343
Mailing Address - Fax:859-879-0434
Practice Address - Street 1:426 LEXINGTON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1798
Practice Address - Country:US
Practice Address - Phone:859-873-7343
Practice Address - Fax:859-879-0434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice