Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 10552 | CT |
NPI | 1023306750 |
---|---|
Provider Name | Dr. Kimberly A Farrell |
First Address | Farmington, CT 06030-3905 |
Second Address | Farmington, CT 06030-3609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2011 |
Last Update Date | 26/10/2017 |