Provider Demographics
NPI:1063088847
Name:JOSEPH H HOURIHAN
Entity type:Organization
Organization Name:JOSEPH H HOURIHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-222-7711
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-0508
Mailing Address - Country:US
Mailing Address - Phone:803-222-7711
Mailing Address - Fax:
Practice Address - Street 1:201 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-1008
Practice Address - Country:US
Practice Address - Phone:803-222-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ20353Medicaid