Individual provider Active NPI

David Wayne Farnsworth, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Clovis, NM
National Provider Identifier
1174772784
Registry record updated Apr 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
DD3765 Issued in NM
Practice address
901 E 21St St Ste B
Clovis, NM 88101-4492
Phone
(575) 762-4794
NPI assigned
Sep 18, 2008
Last updated
Apr 7, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 7520 AZ
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X DD3765 NM Primary

Addresses

Primary practice location

901 E 21St St Ste B
Clovis, NM 88101-4492

Mailing address

901 E 21St St Ste B
Clovis, NM 88101-4492
Phone (575) 762-4794

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
7520AZMDOrthodontics and Dentofacial Orthopedic Dentist
DD3765NMMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
David Farnsworth Orthodontics PC Past Accepting new patients
Farnsworth Orthodontics, PLLC Orthodontics and Dentofacial Orthopedics Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396828800000",
    "number": "1174772784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E 21ST ST STE B",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014492",
            "telephone_number": "575-762-4794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 E 21ST ST STE B",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014492",
            "telephone_number": "575-762-4794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARNSWORTH",
        "first_name": "DAVID",
        "middle_name": "WAYNE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-18",
        "last_updated": "2014-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AZ",
            "license": "7520",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NM",
            "license": "DD3765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.