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NPI Code Detail

MEDICARE: EASLEY DENTAL ASSOCIATES

MEDICARE: EASLEY DENTAL ASSOCIATES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1302R00000XHealth Maintenance OrganizationSC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700144300
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASLEY DENTAL ASSOCIATES
Provider Business Mailing Address
First Line : 1040 S PENDLETON ST STE C
Second Line :
City : EASLEY
State : SC
Zip : 29642-1047
Country : US
Telephone Number : 864-306-0800
Fax Number :
Provider Business Practice Location Address
First Line : 1040 S PENDLETON ST STE C
Second Line :
City : EASLEY
State : SC
Zip : 29642-1047
Country : US
Telephone Number : 864-306-0800
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MIR JIM NASIM
Credential :
Telephone Number : 864-306-0800
Provider Enumeration Date : 05/02/2012
Last Update Date : 05/02/2012

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Directions to “EASLEY DENTAL ASSOCIATES ” Practice Location

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