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General NPI Number Information
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NPI Number | 1063157287
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Entity Type | Organization
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Legal Business Name | PROGRIN DENTAL OF WESTSIDE, LLC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 108 MICHELIN BLVD
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City | ANDERSON
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State | SC
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Zip | 29625-2676
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Country | US
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Telephone | 864-332-4117
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Fax |
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Provider Business Mailing Address
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Address Line | 201 OLD BOILING SPRINGS RD STE A
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City | GREER
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State | SC
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Zip | 29650-4257
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Country | US
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Telephone | 864-561-7559
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Fax |
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Authorized Official
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Title or Position | COO
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Name | BRENT AYERS
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Credential |
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Telephone | 864-561-7559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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