Individual
CHRISTINA WEAVER FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
109 ANNA AVE, BLANDON, PA 19510
(610) 926-1233
(610) 916-7640
Mailing address
PO BOX 260, BLANDON, PA 19510
(610) 926-1233
(610) 916-7640
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS042101
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1036507360001
—
PA
Enumeration date
06/24/2018
Last updated
10/10/2019
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