Provider Demographics
NPI:1508113234
Name:DENTNOW CORPORATION GREENVILLE
Entity Type:Organization
Organization Name:DENTNOW CORPORATION GREENVILLE
Other - Org Name:DENTNOW GREENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAFE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAMBRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-232-8100
Mailing Address - Street 1:1639 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5930
Mailing Address - Country:US
Mailing Address - Phone:864-232-8100
Mailing Address - Fax:864-232-8102
Practice Address - Street 1:1639 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5930
Practice Address - Country:US
Practice Address - Phone:864-232-8100
Practice Address - Fax:864-232-8102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTNOW CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty