Provider Demographics
NPI:1811536881
Name:FOUNDATION DENTAL PARTNERS SOUTH CAROLINA PC
Entity Type:Organization
Organization Name:FOUNDATION DENTAL PARTNERS SOUTH CAROLINA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF INTEGRATION AND ADMINISTRATIO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-743-9474
Mailing Address - Street 1:296 S MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3026 FARROW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7002
Practice Address - Country:US
Practice Address - Phone:803-255-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty