Provider Demographics
NPI:1639209133
Name:JOHN C BILDER DMD PA
Entity Type:Organization
Organization Name:JOHN C BILDER DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-464-2099
Mailing Address - Street 1:410 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574
Mailing Address - Country:US
Mailing Address - Phone:843-464-2099
Mailing Address - Fax:843-464-4432
Practice Address - Street 1:410 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574
Practice Address - Country:US
Practice Address - Phone:843-464-2099
Practice Address - Fax:843-464-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC23911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC444915Medicaid
NC8990714Medicaid
SCZA9417Medicaid