Provider Demographics
NPI:1992116313
Name:HARRELL, ADAM CHRISTIAN
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:CHRISTIAN
Last Name:HARRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ADAM
Other - Middle Name:C
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:110 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5936
Mailing Address - Country:US
Mailing Address - Phone:252-355-2424
Mailing Address - Fax:252-355-2701
Practice Address - Street 1:110 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5936
Practice Address - Country:US
Practice Address - Phone:252-355-2424
Practice Address - Fax:252-355-2701
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist