Provider Demographics
NPI:1407066533
Name:PALMETTO FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:PALMETTO FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:STANFORD
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-233-0427
Mailing Address - Street 1:870 CLEVELAND ST
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4427
Mailing Address - Country:US
Mailing Address - Phone:864-233-0427
Mailing Address - Fax:864-271-2295
Practice Address - Street 1:870 CLEVELAND ST
Practice Address - Street 2:SUITE 1-A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4427
Practice Address - Country:US
Practice Address - Phone:864-233-0427
Practice Address - Fax:864-271-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC34001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty