Provider Demographics
NPI:1437421690
Name:SALUDA DENTAL GROUP
Entity Type:Organization
Organization Name:SALUDA DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-576-7169
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-0309
Mailing Address - Country:US
Mailing Address - Phone:864-445-8168
Mailing Address - Fax:864-445-2535
Practice Address - Street 1:101 R.L. SAWYER M.D. DRIVE
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-0309
Practice Address - Country:US
Practice Address - Phone:864-445-8168
Practice Address - Fax:864-445-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty