Individual
ETHAN G FARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4082 N RICHMOND ST, APPLETON, WI 54913-9704
(920) 734-9148
Mailing address
5433 N JASPER LN, APPLETON, WI 54913-2776
(920) 660-5799
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6001184
WI
261QM1300X
Multi-Specialty Clinic/Center
6001184
WI
332BC3200X
Customized Equipment (DME)
6001184
WI
Other
Enumeration date
06/14/2023
Last updated
05/13/2026
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