Provider Demographics
NPI:1700946241
Name:FARLEY, MARK D (DMD ORTHODONTIST)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:FARLEY
Suffix:
Gender:M
Credentials:DMD ORTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SOUTH SHAW LANE
Mailing Address - Street 2:
Mailing Address - City:FT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075
Mailing Address - Country:US
Mailing Address - Phone:859-441-1487
Mailing Address - Fax:
Practice Address - Street 1:1809 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076
Practice Address - Country:US
Practice Address - Phone:859-441-7900
Practice Address - Fax:859-441-5025
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY56701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics