Provider Demographics
NPI:1154508943
Name:BRANDON KENT FARRELL, DDS, PA
Entity Type:Organization
Organization Name:BRANDON KENT FARRELL, DDS, PA
Other - Org Name:BRUSH DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:K
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-762-1212
Mailing Address - Street 1:115 N 3RD ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4086
Mailing Address - Country:US
Mailing Address - Phone:910-762-1212
Mailing Address - Fax:910-762-1226
Practice Address - Street 1:115 N 3RD ST
Practice Address - Street 2:SUITE 308
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4086
Practice Address - Country:US
Practice Address - Phone:910-762-1212
Practice Address - Fax:910-762-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty