Provider Demographics
NPI:1801978598
Name:FARRELL, BRANDON KENT (DDS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:KENT
Last Name:FARRELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 WINDCHIME DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7375
Mailing Address - Country:US
Mailing Address - Phone:910-632-5497
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice