Provider Demographics
NPI:1437852787
Name:COVE DENTAL OF EASLEY
Entity Type:Organization
Organization Name:COVE DENTAL OF EASLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-269-0600
Mailing Address - Street 1:105 SHERINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-2615
Mailing Address - Country:US
Mailing Address - Phone:864-269-0600
Mailing Address - Fax:864-269-0619
Practice Address - Street 1:105 SHERINGHAM DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-2615
Practice Address - Country:US
Practice Address - Phone:864-269-0600
Practice Address - Fax:864-269-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental