Provider Demographics
NPI:1225183932
Name:DR. F. BENNY ERWIN
Entity Type:Organization
Organization Name:DR. F. BENNY ERWIN
Other - Org Name:FOOTHILLS DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARCENGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-647-2000
Mailing Address - Street 1:215 LUCKY ST
Mailing Address - Street 2:P O BOX 237
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-1855
Mailing Address - Country:US
Mailing Address - Phone:864-647-2000
Mailing Address - Fax:864-647-3736
Practice Address - Street 1:215 LUCKY ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1855
Practice Address - Country:US
Practice Address - Phone:864-647-2000
Practice Address - Fax:864-647-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA91571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty