Provider Demographics
NPI:1013316231
Name:PLEASANTBURG DRIVE DENTAL HEALTH CENTER, P.C.
Entity Type:Organization
Organization Name:PLEASANTBURG DRIVE DENTAL HEALTH CENTER, P.C.
Other - Org Name:PLEASANTBURG FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-233-7737
Mailing Address - Street 1:225 S PLEASANTBURG DR STE E10
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2533
Mailing Address - Country:US
Mailing Address - Phone:864-233-7737
Mailing Address - Fax:
Practice Address - Street 1:225 S PLEASANTBURG DR STE E10
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2533
Practice Address - Country:US
Practice Address - Phone:864-233-7737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty