Provider Demographics
NPI:1063552206
Name:ROCKY CREEK DENTAL CARE
Entity type:Organization
Organization Name:ROCKY CREEK DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-235-1200
Mailing Address - Street 1:1322 E WASHINGTON ST
Mailing Address - Street 2:STE. D1
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1866
Mailing Address - Country:US
Mailing Address - Phone:864-235-1200
Mailing Address - Fax:
Practice Address - Street 1:1322 E WASHINGTON ST
Practice Address - Street 2:STE. D1
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1866
Practice Address - Country:US
Practice Address - Phone:864-235-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30681223G0001X
SC36161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty