Healthcare Provider Details

I. General information

NPI: 1972554186
Provider Name (Legal Business Name): DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 BILLINGSLEY RD SUITE 105
CHARLOTTE NC
28211-1066
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 704-347-3900
  • Fax: 704-347-0133
Mailing address:
  • Phone: 704-295-4653
  • Fax: 704-295-4288

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 BILLING
Credential:
Phone: 704-295-4653