Provider Demographics
NPI:1720482292
Name:HNBRMH LLC
Entity Type:Organization
Organization Name:HNBRMH LLC
Other - Org Name:SOUTHERN EDGE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOBOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-242-2848
Mailing Address - Street 1:119 W ANTRIM DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2505
Mailing Address - Country:US
Mailing Address - Phone:864-242-2848
Mailing Address - Fax:864-242-2844
Practice Address - Street 1:119 W ANTRIM DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2505
Practice Address - Country:US
Practice Address - Phone:864-242-2848
Practice Address - Fax:864-242-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty