Provider Demographics
NPI:1215987797
Name:FARNSWORTH, RUSSELL WIRTHLIN (DDS)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:WIRTHLIN
Last Name:FARNSWORTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 W 10400 S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8953
Mailing Address - Country:US
Mailing Address - Phone:801-446-1515
Mailing Address - Fax:801-446-5290
Practice Address - Street 1:2651 W 10400 S
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8953
Practice Address - Country:US
Practice Address - Phone:801-446-1515
Practice Address - Fax:801-446-5290
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56679381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry