1649344169 NPI number — DR. CHERAE MONTALISA FARMER D.D.S.

Table of content: DR. CHERAE MONTALISA FARMER D.D.S. (NPI 1649344169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649344169 NPI number — DR. CHERAE MONTALISA FARMER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARMER
Provider First Name:
CHERAE
Provider Middle Name:
MONTALISA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARMER-DIXON
Provider Other First Name:
CHERAE
Provider Other Middle Name:
MONTALISA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649344169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1421 TIMBER VALLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37214-4324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-351-0551
Provider Business Mailing Address Fax Number:
615-327-6074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3803 HYDES FERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37218-2645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-244-5269
Provider Business Practice Location Address Fax Number:
615-327-6074
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5300 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)