Provider Demographics
NPI:1326118464
Name:PIEDMONT DENTAL CENTER
Entity Type:Organization
Organization Name:PIEDMONT DENTAL CENTER
Other - Org Name:CHARLESTON DENTURE CENTER , COLUMBIA DENTURE CENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-582-4308
Mailing Address - Street 1:975 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4104
Mailing Address - Country:US
Mailing Address - Phone:864-582-4308
Mailing Address - Fax:864-596-4492
Practice Address - Street 1:975 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4104
Practice Address - Country:US
Practice Address - Phone:864-582-4308
Practice Address - Fax:864-596-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890298UMedicaid