1205694866 NPI number — REA FARMS PEDIATRIC DENTISTRY PARTNERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205694866 NPI number — REA FARMS PEDIATRIC DENTISTRY PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REA FARMS PEDIATRIC DENTISTRY PARTNERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205694866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11210 GOLF LINKS DR N STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28277-8049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-343-5998
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11210 GOLF LINKS DR N
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-343-5998
Provider Business Practice Location Address Fax Number:
704-612-6920
Provider Enumeration Date:
03/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HUKILL
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
ATLAS
Authorized Official Title or Position:
PEDIATRIC DENTIST
Authorized Official Telephone Number:
704-458-2093

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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