Provider Demographics
NPI:1548388168
Name:ANDERSON FAMILY DENTAL CARE PA
Entity Type:Organization
Organization Name:ANDERSON FAMILY DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST GENERAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-226-8040
Mailing Address - Street 1:1411 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:864-226-8040
Mailing Address - Fax:864-225-9965
Practice Address - Street 1:1411 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:864-226-8040
Practice Address - Fax:864-225-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32671223G0001X
SC32881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9635Medicaid