Provider Demographics
NPI:1669874053
Name:A HEALTHY SMILE
Entity type:Organization
Organization Name:A HEALTHY SMILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER; GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-282-6143
Mailing Address - Street 1:221 FAIRFOREST WAY
Mailing Address - Street 2:APT 6102
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4629
Mailing Address - Country:US
Mailing Address - Phone:919-282-6143
Mailing Address - Fax:
Practice Address - Street 1:1658 CRANIUM DR
Practice Address - Street 2:SUITE NUMBER 106
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3506
Practice Address - Country:US
Practice Address - Phone:919-282-6143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty