Provider Demographics
NPI:1265793228
Name:FARRAR, MICHAEL RYAN (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:FARRAR
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 1:2066 HWY 45 BY PASS SOUTH
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382
Mailing Address - Country:US
Mailing Address - Phone:731-855-1053
Mailing Address - Fax:731-855-8064
Practice Address - Street 1:2066 HIGHWAY 45 BY PASS
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-9998
Practice Address - Country:US
Practice Address - Phone:731-855-1053
Practice Address - Fax:731-855-8064
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist