Organization
FARREY FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAJUANA PEARLDEALIA FARREY DMD (DENTAL DIRECTOR)
(229) 890-3908
Entity
Organization
Contact information
Practice address
513 S MAIN ST, MOULTRIE, GA 31768-4637
(229) 890-3908
(229) 890-3909
Mailing address
PO BOX 2229, MOULTRIE, GA 31776-2229
(229) 890-3908
(229) 890-3909
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013880
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148974731B
—
GA
Enumeration date
03/27/2011
Last updated
06/29/2022
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