| Organization Name: | FARWELL DENTAL CLINIC |
| NPI Number: | 1891127221 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOYCE ROE IVINS (OWNER) |
| Mailing Address: | 303 3rd St Farwell |
| State: | TX US |
| Postal Code: | 793254669 |
| Phone Number: | 8064813336 |
| Fax Number: | 8064813339 |
| NPI Enumeration Date: | 08/08/2013 |
| NPI Last Update Date: | 08/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 11608 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |