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General NPI Number Information
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NPI Number | 1215337167
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Entity Type | Organization
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Legal Business Name | K & N DENTAL GROUP LLC
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 111 POWELL MILL RD
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City | SPARTANBURG
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State | SC
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Zip | 29301-1590
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Country | US
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Telephone | 864-574-0788
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Fax | 864-576-5359
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Provider Business Mailing Address
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Address Line | 125 TOWNPARK DR NW SUITE 180
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City | KENNESAW
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State | GA
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Zip | 30144-5803
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Country | US
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Telephone | 404-410-1343
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JIM NASIM
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Credential |
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Telephone | 864-576-7169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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