Provider Demographics
NPI:1619926128
Name:PELHAM LINKS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:PELHAM LINKS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WALDROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-297-6365
Mailing Address - Street 1:PO BOX 27143
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-2143
Mailing Address - Country:US
Mailing Address - Phone:864-297-6365
Mailing Address - Fax:864-297-7080
Practice Address - Street 1:201 OLD BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:864-297-6365
Practice Address - Fax:864-297-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9722Medicaid