Provider Demographics
NPI:1962707380
Name:TRINITY DENTAL CARE LLC
Entity type:Organization
Organization Name:TRINITY DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-225-6321
Mailing Address - Street 1:100 BALTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4292
Mailing Address - Country:US
Mailing Address - Phone:864-225-6321
Mailing Address - Fax:864-752-1631
Practice Address - Street 1:1221 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4821
Practice Address - Country:US
Practice Address - Phone:864-224-4736
Practice Address - Fax:864-752-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental