Provider Demographics
NPI:1427272871
Name:SALUDA SMILES FAMILY DENTISTRY, P.A.
Entity type:Organization
Organization Name:SALUDA SMILES FAMILY DENTISTRY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-445-8168
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-0309
Mailing Address - Country:US
Mailing Address - Phone:864-445-8168
Mailing Address - Fax:864-445-2535
Practice Address - Street 1:101 R L SAWYER MD DR
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-9199
Practice Address - Country:US
Practice Address - Phone:864-445-8168
Practice Address - Fax:864-445-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9747Medicaid