Provider Demographics
NPI:1326554841
Name:POWDERSVILLE FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:POWDERSVILLE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-386-2753
Mailing Address - Street 1:PO BOX 31625
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29608-1625
Mailing Address - Country:US
Mailing Address - Phone:864-501-0070
Mailing Address - Fax:
Practice Address - Street 1:102 CLAIR DR
Practice Address - Street 2:
Practice Address - City:POWDERSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29673-7771
Practice Address - Country:US
Practice Address - Phone:864-269-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental