Healthcare Provider Details

I. General information

NPI: 1326250762
Provider Name (Legal Business Name): SCOTT CARL FARRELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 WISTERIA DR STE 300
SNELLVILLE GA
30078-4604
US

IV. Provider business mailing address

2220 WISTERIA DR STE 300
SNELLVILLE GA
30078-4604
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-2107
  • Fax:
Mailing address:
  • Phone: 678-836-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3904
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901017310
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25210
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015126
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: