Provider Demographics
NPI:1952524969
Name:THANE S. FARMER, DDS
Entity Type:Organization
Organization Name:THANE S. FARMER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-267-7073
Mailing Address - Street 1:50 STREET OF DREAMS
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1135
Mailing Address - Country:US
Mailing Address - Phone:304-267-7073
Mailing Address - Fax:304-267-4124
Practice Address - Street 1:50 STREET OF DREAMS
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1135
Practice Address - Country:US
Practice Address - Phone:304-267-7073
Practice Address - Fax:304-267-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherMETLIFE