Healthcare Provider Details

I. General information

NPI: 1740994391
Provider Name (Legal Business Name): POINSETT DENTAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W POINSETT ST STE B
GREER SC
29650-1945
US

IV. Provider business mailing address

215 W POINSETT ST STE B
GREER SC
29650-1945
US

V. Phone/Fax

Practice location:
  • Phone: 864-877-1891
  • Fax:
Mailing address:
  • Phone: 864-877-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WESLEY HARDEN
Title or Position: OWNER
Credential: DMD
Phone: 864-877-1891