Ethan G Farr, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6001184 Issued in WI

Practice address

4082 N Richmond St
Appleton, WI 54913-9704

Phone

(920) 734-9148

NPI assigned

Jun 14, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Grand Avenue Dental Care, LLC

  • Dental Clinic/Center
  • Hartford, WI
  • NPI 1255102323
  NPD
• Peter F Wilk D.D.S.

  • Dentist
  • Hartford, WI
  • NPI 1679864631
  NPD (past)

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778630400000",
    "number": "1609550169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5433 N JASPER LN",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549132776",
            "telephone_number": "920-660-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4082 N RICHMOND ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549139704",
            "telephone_number": "920-734-9148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARR",
        "first_name": "ETHAN",
        "middle_name": "G",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-14",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "WI",
            "license": "6001184",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "WI",
            "license": "6001184",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6001184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chenhao Fan, M.D.
• Alice A Fara, RN
• Anne Farley, PT
• Katherine M Farley, APNP
• Paul Farley, PHARMD
• Farrar and Associates Mental Health SC
• Tasha Farrar, MD
• Wendy L Fassbender, OTA
• Mark W Faustich, MD
• Amy Fazel

• General Practice Dentistry in Appleton, WI
• Providers in Appleton, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; 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.