Provider Demographics
NPI:1578688875
Name:FIVE FORKS DENTAL CARE, INC
Entity Type:Organization
Organization Name:FIVE FORKS DENTAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAPNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-289-0289
Mailing Address - Street 1:2833 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4807
Mailing Address - Country:US
Mailing Address - Phone:864-289-0289
Mailing Address - Fax:
Practice Address - Street 1:2833 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4807
Practice Address - Country:US
Practice Address - Phone:864-289-0289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty