Provider Demographics
NPI:1346513801
Name:FAMILY DENTAL HEALTH OF EASLEY, LLC
Entity Type:Organization
Organization Name:FAMILY DENTAL HEALTH OF EASLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:SAFRIT
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-282-1935
Mailing Address - Street 1:400 MEMORIAL DRIVE EXT STE 400
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1850
Mailing Address - Country:US
Mailing Address - Phone:864-282-1935
Mailing Address - Fax:864-751-6387
Practice Address - Street 1:9 SOUTHERN CENTER COURT
Practice Address - Street 2:SUITE B
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-1447
Practice Address - Country:US
Practice Address - Phone:864-306-8350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FDH HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4138122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty