MEDICARE: DR. BRIAN B FARRELL DDS,MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8059	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1368K	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679547483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN B FARRELL DDS,MD

Provider Business Mailing Address
First Line	:	411 BILLINGSLEY RD
Second Line	:	SUITE 105
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1066
Country	:	US
Telephone Number	:	704-347-3900
Fax Number	:	704-347-0133

Provider Business Practice Location Address
First Line	:	411 BILLINGSLEY RD
Second Line	:	SUITE 105
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1066
Country	:	US
Telephone Number	:	704-347-3900
Fax Number	:	704-347-0133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	07/08/2007

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