Provider Demographics
NPI:1760109870
Name:FAMILY DENTAL HEALTH OF SPRING VALLEY LLC
Entity Type:Organization
Organization Name:FAMILY DENTAL HEALTH OF SPRING VALLEY LLC
Other - Org Name:FDH HOLDINGS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ILSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
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:864-751-6387
Practice Address - Street 1:9 OFFICE PARK CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5957
Practice Address - Country:US
Practice Address - Phone:803-788-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FDH HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty