Provider Demographics
NPI:1225285646
Name:RADIANT DENTISTRY
Entity Type:Organization
Organization Name:RADIANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:WREN
Authorized Official - Last Name:LEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-621-5366
Mailing Address - Street 1:1440 FERNWOOD GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-3079
Mailing Address - Country:US
Mailing Address - Phone:864-582-2950
Mailing Address - Fax:
Practice Address - Street 1:1440 FERNWOOD GLENDALE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-3079
Practice Address - Country:US
Practice Address - Phone:864-582-2950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty