1841089430 NPI number — FAMILY DENTAL HEALTH GROUP LLC

Table of content: (NPI 1841089430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841089430 NPI number — FAMILY DENTAL HEALTH GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY DENTAL HEALTH GROUP LLC
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:
1841089430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 MEMORIAL DRIVE EXT STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29651-1850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-282-1935
Provider Business Mailing Address Fax Number:
864-751-6387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 PELHAM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-776-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2025

Additional Information

Authorized Official

Authorized Official Last Name:
ILLSLEY
Authorized Official First Name:
BETH
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
INSURANCE DIRECTOR
Authorized Official Telephone Number:
864-282-1935

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com