Provider Demographics
NPI:1518218486
Name:TRIAD DENTAL GROUP
Entity Type:Organization
Organization Name:TRIAD DENTAL GROUP
Other - Org Name:THE BRIGHT SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-706-1651
Mailing Address - Street 1:108 BURTON ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5400
Mailing Address - Country:US
Mailing Address - Phone:864-576-7169
Mailing Address - Fax:864-576-8389
Practice Address - Street 1:3425 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7725
Practice Address - Country:US
Practice Address - Phone:864-295-8678
Practice Address - Fax:864-295-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty