Provider Demographics
NPI:1427766823
Name:BLUE RIDGE DENTAL LLC
Entity type:Organization
Organization Name:BLUE RIDGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-580-8767
Mailing Address - Street 1:2224 OLD FURNACE RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5782
Mailing Address - Country:US
Mailing Address - Phone:864-586-5050
Mailing Address - Fax:
Practice Address - Street 1:2224 OLD FURNACE RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5782
Practice Address - Country:US
Practice Address - Phone:864-586-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental