Provider Demographics
NPI:1912925835
Name:G. J. FARREN, DMD, PC
Entity Type:Organization
Organization Name:G. J. FARREN, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-866-5591
Mailing Address - Street 1:379 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-4213
Mailing Address - Country:US
Mailing Address - Phone:207-866-5591
Mailing Address - Fax:207-866-2445
Practice Address - Street 1:379 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-4213
Practice Address - Country:US
Practice Address - Phone:207-866-5591
Practice Address - Fax:207-866-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME26961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty