Healthcare Provider Details

I. General information

NPI: 1649832510
Provider Name (Legal Business Name): PROGRIN DENTAL OF POWDERSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 11/17/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10705 ANDERSON RD
EASLEY SC
29642-8298
US

IV. Provider business mailing address

201 OLD BOILING SPRINGS RD STE A
GREER SC
29650-4257
US

V. Phone/Fax

Practice location:
  • Phone: 864-561-7559
  • Fax:
Mailing address:
  • Phone: 864-561-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. BRENT ALLEN AYERS
Title or Position: COO
Credential:
Phone: 864-561-7559