Provider Demographics
NPI:1437263639
Name:ANDERSON ORTHODONTIC ASSOCIATES PA
Entity Type:Organization
Organization Name:ANDERSON ORTHODONTIC ASSOCIATES PA
Other - Org Name:BC MCCONNELL JR DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEELHAND
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-225-0892
Mailing Address - Street 1:1527 NORTH FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-225-0380
Mailing Address - Fax:864-225-0892
Practice Address - Street 1:1527 NORTH FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-225-0380
Practice Address - Fax:864-225-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty