Provider Demographics
NPI:1215648084
Name:PROGRIN DENTAL OF AUGUSTA ROAD LLC
Entity type:Organization
Organization Name:PROGRIN DENTAL OF AUGUSTA ROAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-561-7559
Mailing Address - Street 1:201 OLD BOILING SPRINGS RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4257
Mailing Address - Country:US
Mailing Address - Phone:864-561-7559
Mailing Address - Fax:
Practice Address - Street 1:1 W PRENTISS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4029
Practice Address - Country:US
Practice Address - Phone:864-607-8848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental