Provider Demographics
NPI:1467641365
Name:FAHRNEY, CHRISTOPHER RANDALL (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RANDALL
Last Name:FAHRNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1821
Mailing Address - Country:US
Mailing Address - Phone:704-372-5411
Mailing Address - Fax:
Practice Address - Street 1:1927 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1821
Practice Address - Country:US
Practice Address - Phone:704-372-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist