MEDICARE: FD BILLING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1154196020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FD BILLING LLC

Provider Business Mailing Address
First Line	:	11840 SOUTHMORE DR STE 150
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0785
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11840 SOUTHMORE DR STE 150
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0785
Country	:	US
Telephone Number	:	704-246-6051
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JEFF COHEN
Credential	:
Telephone Number	:	704-246-8971

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	11/20/2023

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