Provider Demographics
NPI:1891372710
Name:FLAT ROCK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:FLAT ROCK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:OLCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PA
Authorized Official - Phone:828-693-0911
Mailing Address - Street 1:520 S ALLEN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-9451
Mailing Address - Country:US
Mailing Address - Phone:828-693-0911
Mailing Address - Fax:828-693-9529
Practice Address - Street 1:520 S ALLEN RD STE 4
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-9451
Practice Address - Country:US
Practice Address - Phone:828-693-0911
Practice Address - Fax:828-693-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty