Active NPI
Amanda Pearl Farley, DDS
- Dentist
- Modesto, CA
National Provider Identifier
1427391044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 63720
- Practice address
- 1213 Coffee Rd
Suite C
Modesto, CA 95355-4229 - Phone
- (209) 571-3006
- Fax
- (209) 571-8256
- NPI assigned
- Apr 2, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 63720 | CA | Primary |
Addresses
Primary practice location
1213 Coffee Rd
Suite C
Modesto, CA 95355-4229
Mailing address
1213 Coffee Rd
Suite C
Modesto, CA 95355-4229
Phone (209) 571-3006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 22, 2016 through Jan 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63720 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406246400000",
"number": "1427391044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1213 COFFEE RD",
"address_2": "SUITE C",
"city": "MODESTO",
"state": "CA",
"postal_code": "953554229",
"telephone_number": "209-571-3006",
"fax_number": "209-571-8256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1213 COFFEE RD",
"address_2": "SUITE C",
"city": "MODESTO",
"state": "CA",
"postal_code": "953554229",
"telephone_number": "209-571-3006",
"fax_number": "209-571-8256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARLEY",
"first_name": "AMANDA",
"middle_name": "PEARL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-02",
"last_updated": "2014-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "63720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.