Provider Demographics
NPI:1295584365
Name:KEVIN M FARLEY DMD PLLC
Entity type:Organization
Organization Name:KEVIN M FARLEY DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-592-6067
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-0127
Mailing Address - Country:US
Mailing Address - Phone:801-592-6067
Mailing Address - Fax:
Practice Address - Street 1:805 S 500 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-3203
Practice Address - Country:US
Practice Address - Phone:801-592-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental