Provider Demographics
NPI:1619325107
Name:FAMILY DENTAL HEALTH OF CLEVELAND STREET, LLC
Entity Type:Organization
Organization Name:FAMILY DENTAL HEALTH OF CLEVELAND STREET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:SAFRIT
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-282-1935
Mailing Address - Street 1:400 MEMORIAL DRIVE EXT STE 400
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1850
Mailing Address - Country:US
Mailing Address - Phone:864-282-1935
Mailing Address - Fax:864-282-1955
Practice Address - Street 1:1352 CLEVELAND ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2437
Practice Address - Country:US
Practice Address - Phone:864-371-6032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FDH HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-25
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty