Provider Demographics
NPI:1073744124
Name:ORAL SURGERY & IMPLANT ASSOCIATES OF GREENVILLE, LLC
Entity Type:Organization
Organization Name:ORAL SURGERY & IMPLANT ASSOCIATES OF GREENVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:864-234-8811
Mailing Address - Street 1:10 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6301
Mailing Address - Country:US
Mailing Address - Phone:864-234-8811
Mailing Address - Fax:864-234-8844
Practice Address - Street 1:10 ENTERPRISE BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6301
Practice Address - Country:US
Practice Address - Phone:864-234-8811
Practice Address - Fax:864-234-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty