Provider Demographics
NPI:1376566356
Name:AIKEN FAMILY DENTAL PA
Entity type:Organization
Organization Name:AIKEN FAMILY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HOLDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-649-0044
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29802-1057
Mailing Address - Country:US
Mailing Address - Phone:803-649-0044
Mailing Address - Fax:803-643-0570
Practice Address - Street 1:341 NEWBERRY STREET NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-649-0044
Practice Address - Fax:803-643-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty