Provider Demographics
NPI:1003253758
Name:WILLIAMSTON FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:WILLIAMSTON FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-847-4545
Mailing Address - Street 1:312 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-1900
Mailing Address - Country:US
Mailing Address - Phone:864-847-4545
Mailing Address - Fax:864-847-5307
Practice Address - Street 1:312 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-1900
Practice Address - Country:US
Practice Address - Phone:864-847-4545
Practice Address - Fax:864-847-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty