Provider Demographics
NPI:1386071181
Name:DENTAL PROFESSIONALS OF SC, PC
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF SC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOELSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1494 WEST WADE HAMPTON BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1129
Mailing Address - Country:US
Mailing Address - Phone:864-416-7092
Mailing Address - Fax:
Practice Address - Street 1:1494 WEST WADE HAMPTON BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1129
Practice Address - Country:US
Practice Address - Phone:864-416-7092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF SC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty