Provider Demographics
NPI:1750584975
Name:BOILING SPRINGS DENTISTRY, LLC
Entity type:Organization
Organization Name:BOILING SPRINGS DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GRANTHAM
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-578-0043
Mailing Address - Street 1:PO BOX 161329
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-0023
Mailing Address - Country:US
Mailing Address - Phone:864-578-0043
Mailing Address - Fax:864-578-0044
Practice Address - Street 1:107 PARRIS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-1924
Practice Address - Country:US
Practice Address - Phone:864-578-0043
Practice Address - Fax:864-578-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty