Provider Demographics
NPI:1598830697
Name:ORAL SURGERY ASSOCIATES,PA
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-234-8811
Mailing Address - Street 1:10 ENTERPRISE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3554
Mailing Address - Country:US
Mailing Address - Phone:864-234-8811
Mailing Address - Fax:864-234-8844
Practice Address - Street 1:10 ENTERPRISE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3554
Practice Address - Country:US
Practice Address - Phone:864-234-8811
Practice Address - Fax:864-234-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1588282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1588OtherLICENSE
SC115OtherSPECIALTY
SC0001588OtherDELTA SC PROVIDER
SCAH5385732OtherBNDD#
SCZ15889Medicaid
SCAH5385732OtherBNDD#