Healthcare Provider Details

I. General information

NPI: 1598586307
Provider Name (Legal Business Name): DRS FARRELL FARRELL NALE COOK KAPITAN MOHAMED FRANCO WESSEL HOWELL & K
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9335 BLAKENEY CENTRE DR STE 130
CHARLOTTE NC
28277-6665
US

IV. Provider business mailing address

5550 77 CENTER DR STE 320
CHARLOTTE NC
28217-0739
US

V. Phone/Fax

Practice location:
  • Phone: 704-541-7761
  • Fax:
Mailing address:
  • Phone: 704-295-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER RAYLE HOCK
Title or Position: DIRECTOR OF PAYOR RELATIONS
Credential:
Phone: 704-295-4653