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General NPI Number Information
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NPI Number | 1972554186
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Entity Type | Organization
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Legal Business Name | DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 411 BILLINGSLEY RD SUITE 105
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City | CHARLOTTE
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State | NC
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Zip | 28211-1066
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Country | US
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Telephone | 704-347-3900
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Fax | 704-347-0133
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Provider Business Mailing Address
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Address Line | 5550 77 CENTER DR STE 320
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City | CHARLOTTE
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State | NC
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Zip | 28217-0739
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Country | US
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Telephone | 704-295-4653
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Fax | 704-295-4288
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Authorized Official
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Title or Position | DIRECTOR OF BILLING
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Name | MRS. JENNIFER RAYLE HOCK
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Credential |
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Telephone | 704-295-4653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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