Healthcare Provider Details

I. General information

NPI: 1942142567
Provider Name (Legal Business Name): EVELINA SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MILACRON DR.
FOUNTAIN INN SC
29644
US

IV. Provider business mailing address

5052 OLD BUNCOMBE RD STE A
GREENVILLE SC
29617-8260
US

V. Phone/Fax

Practice location:
  • Phone: 864-387-9748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RICHARD CONSTANTINE
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 864-387-9748