Provider Demographics
NPI:1609769710
Name:FAMILY DENTAL HEALTH GROUP
Entity type:Organization
Organization Name:FAMILY DENTAL HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ILLSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-282-1935
Mailing Address - Street 1:400 MEMORIAL DRIVE EXT STE 400
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1850
Mailing Address - Country:US
Mailing Address - Phone:864-282-1935
Mailing Address - Fax:864-751-6387
Practice Address - Street 1:1860 COLTHARP RD
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8978
Practice Address - Country:US
Practice Address - Phone:803-802-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FDH HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty