Healthcare Provider Details

I. General information

NPI: 1861913022
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: 06/28/2017
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 EBENEZER ROAD
ROCK HILL SC
29732
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 803-207-8318
  • Fax:
Mailing address:
  • Phone: 704-295-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER RAYLE HOCK
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 704-295-4653