Provider Demographics
NPI:1043737323
Name:FARR, BRYANT CAMERON (DMD)
Entity type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:CAMERON
Last Name:FARR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 ROCKY RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2615
Mailing Address - Country:US
Mailing Address - Phone:480-650-3905
Mailing Address - Fax:
Practice Address - Street 1:PSC 415 BOX 6755
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09114-0068
Practice Address - Country:US
Practice Address - Phone:480-650-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33415122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist