Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 9158 | GA |
NPI | 1003900036 |
---|---|
Provider Name | Dr. Ken H. Farrar |
First Address | Marietta, GA 30064-1016 |
Second Address | Marietta, GA 30064-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |