Provider Demographics
NPI:1962785097
Name:FARR, BRADLEY L (DDS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:L
Last Name:FARR
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 1:625 W SOUTHERN AVE STE E-145
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5030
Mailing Address - Country:US
Mailing Address - Phone:480-332-0577
Mailing Address - Fax:602-483-1635
Practice Address - Street 1:625 W SOUTHERN AVE STE E-145
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5030
Practice Address - Country:US
Practice Address - Phone:480-332-0577
Practice Address - Fax:602-483-1635
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0088831223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology