Provider Demographics
NPI:1588962567
Name:PELHAM LINKS OF SIMPSONVILLE, LLC
Entity type:Organization
Organization Name:PELHAM LINKS OF SIMPSONVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/AR SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WALDROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-297-6365
Mailing Address - Street 1:805 W GEORGIA RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6213
Mailing Address - Country:US
Mailing Address - Phone:864-757-1500
Mailing Address - Fax:
Practice Address - Street 1:201 OLD BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4227
Practice Address - Country:US
Practice Address - Phone:864-297-6365
Practice Address - Fax:864-297-9949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PELHAM LINKS FAMILY & COSMETIC DENTISTRY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty