Provider Demographics
NPI:1467154799
Name:FARMER, MAGAN ALYSSA (DMD)
Entity type:Individual
Prefix:DR
First Name:MAGAN
Middle Name:ALYSSA
Last Name:FARMER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4101
Mailing Address - Country:US
Mailing Address - Phone:563-888-1340
Mailing Address - Fax:
Practice Address - Street 1:888 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4101
Practice Address - Country:US
Practice Address - Phone:563-888-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist