Provider Demographics
NPI:1073901286
Name:HUNT FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:HUNT FAMILY DENTAL, LLC
Other - Org Name:WOOD CREEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:SIMS
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-288-5300
Mailing Address - Street 1:2101 PELHAM RD
Mailing Address - Street 2:PO BOX 25604
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4006
Mailing Address - Country:US
Mailing Address - Phone:864-288-5300
Mailing Address - Fax:864-288-9430
Practice Address - Street 1:2101 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4006
Practice Address - Country:US
Practice Address - Phone:864-288-5300
Practice Address - Fax:864-288-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC19Other19