Provider Demographics
NPI:1619337722
Name:FAMILY ORTHODONTICS OF ANDERSON
Entity Type:Organization
Organization Name:FAMILY ORTHODONTICS OF ANDERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERLIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-437-8606
Mailing Address - Street 1:3416 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3628
Mailing Address - Country:US
Mailing Address - Phone:864-437-8606
Mailing Address - Fax:864-437-8628
Practice Address - Street 1:3416 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3628
Practice Address - Country:US
Practice Address - Phone:864-437-8606
Practice Address - Fax:864-437-8628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHBY PARK PEDIATRIC DENTISTRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0221X
SC36381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty