Walter Kelley Farris, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.032072 Issued in IL

Practice address

1515 N Harlem Ave Ste 200
Oak Park, IL 60302-1277

Phone

(708) 848-2853

NPI assigned

Sep 23, 2019

Last updated

Sep 23, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1569196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1780235655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E ONTARIO ST APT 2506",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114417",
            "telephone_number": "815-861-1308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 N HARLEM AVE STE 200",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021277",
            "telephone_number": "708-848-2853"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 E Calhoun St",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "IL",
            "postal_code": "600984290",
            "country_code": "US",
            "telephone_number": "815-338-7774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FARRIS",
        "first_name": "WALTER",
        "middle_name": "KELLEY",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-23",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.032072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family First Mental Health Services Co (Family First Mental Health)
• Family First Mental Health Services Co (Family First Mental Health)
• Family Medical Care, LTD
• Family Service and Mental Health Center of Cicero
• Brittani Farmer
• Meredith Price Farster, LSW
• Anna Rosa Faso, RD, LDN
• Ambresha Faulk
• Danielle J Faulkner, LCSW
• Stephanie Faulkner, LCSW

• General Practice Dentistry in Oak Park, IL
• Providers in Oak Park, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; 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.