Healthcare Provider Details

I. General information

NPI: 1215387683
Provider Name (Legal Business Name): CAROLINA FAMILY ORTHODONTICS OF GREER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W WADE HAMPTON BLVD
GREER SC
29650-1447
US

IV. Provider business mailing address

400 MEMORIAL DRIVE EXT STE 40
GREER SC
29651-1850
US

V. Phone/Fax

Practice location:
  • Phone: 864-722-2922
  • Fax:
Mailing address:
  • Phone: 864-282-1935
  • Fax: 864-751-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BETH LOUISE ILLSLEY
Title or Position: DIRECTOR OF INSURANCE
Credential:
Phone: 864-282-1935