Provider Demographics
NPI:1295793289
Name:DENTAL ASSOCIATES OF EASLEY, PA
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF EASLEY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-523-5771
Mailing Address - Street 1:415 S PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3051
Mailing Address - Country:US
Mailing Address - Phone:864-859-0111
Mailing Address - Fax:
Practice Address - Street 1:415 S PENDLETON ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3051
Practice Address - Country:US
Practice Address - Phone:864-859-0111
Practice Address - Fax:864-859-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9836Medicaid