Provider Demographics
NPI:1780979500
Name:DAVIDSON, FARRAH BRITNEY (DDS)
Entity type:Individual
Prefix:DR
First Name:FARRAH
Middle Name:BRITNEY
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 DEVON LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7046
Mailing Address - Country:US
Mailing Address - Phone:248-202-2982
Mailing Address - Fax:
Practice Address - Street 1:2041 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4801
Practice Address - Country:US
Practice Address - Phone:248-202-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist