Provider Demographics
NPI:1669778700
Name:FARNSWORTH, BYRON DEREK (DMD)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:DEREK
Last Name:FARNSWORTH
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 1:2947 N POWER RD
Mailing Address - Street 2:STE. E103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1749
Mailing Address - Country:US
Mailing Address - Phone:480-283-5854
Mailing Address - Fax:
Practice Address - Street 1:2947 N POWER RD
Practice Address - Street 2:STE. E103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1749
Practice Address - Country:US
Practice Address - Phone:480-283-5854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0081491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice