Provider Demographics
NPI:1700491685
Name:CCOFS ORAL SURGERY 2 LLC
Entity Type:Organization
Organization Name:CCOFS ORAL SURGERY 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RAYLE
Authorized Official - Last Name:HOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-295-4653
Mailing Address - Street 1:7482 WATERSIDE CROSSING BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-3006
Mailing Address - Country:US
Mailing Address - Phone:704-295-4653
Mailing Address - Fax:704-295-4288
Practice Address - Street 1:4103 E NORTH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2350
Practice Address - Country:US
Practice Address - Phone:864-268-6417
Practice Address - Fax:864-268-3200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS MISIEK, FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED & FRANCO PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty