Healthcare Provider Details

I. General information

NPI: 1548757867
Provider Name (Legal Business Name): PROGRIN DENTAL OF SIMPSONVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 W GEORGIA RD
SIMPSONVILLE SC
29680-6335
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORY AYERS
Title or Position: CEO
Credential: DMD
Phone: 864-561-7559