Provider Demographics
NPI:1376841221
Name:PIEDMONT COMPREHENSIVE DENTAL, LLC
Entity Type:Organization
Organization Name:PIEDMONT COMPREHENSIVE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-277-9343
Mailing Address - Street 1:8024 AUGUSTA RD UNIT G
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-6595
Mailing Address - Country:US
Mailing Address - Phone:864-277-9343
Mailing Address - Fax:864-277-9368
Practice Address - Street 1:8024 AUGUSTA RD UNIT G
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6595
Practice Address - Country:US
Practice Address - Phone:864-277-9343
Practice Address - Fax:864-277-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty