Individual
KATHLEEN WILLIS-FARMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
10590 ENDURING FREEDOM DRIVE, FORT DRUM, NY 13602
(315) 772-6234
Mailing address
10590 ENDURING FREEDOM DRIVE, FORT DRUM, NY 13602-5005
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
19916
CA
124Q00000X
Dental Hygienist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19916
MILITARY BASE
CA
Enumeration date
05/29/2018
Last updated
06/26/2018
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