Provider Demographics
NPI:1285669622
Name:SPARTANBURG DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SPARTANBURG DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-576-7464
Mailing Address - Street 1:233 E BLACKSTOCK RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-2652
Mailing Address - Country:US
Mailing Address - Phone:864-576-7464
Mailing Address - Fax:864-576-9678
Practice Address - Street 1:233 E BLACKSTOCK RD
Practice Address - Street 2:SUITE J
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2652
Practice Address - Country:US
Practice Address - Phone:864-576-7464
Practice Address - Fax:864-576-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty