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General NPI Number Information
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NPI Number | 1225285646
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Entity Type | Organization
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Legal Business Name | RADIANT DENTISTRY
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 1440 FERNWOOD GLENDALE RD
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City | SPARTANBURG
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State | SC
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Zip | 29307-3079
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Country | US
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Telephone | 864-582-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 FERNWOOD GLENDALE RD
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City | SPARTANBURG
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State | SC
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Zip | 29307-3079
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Country | US
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Telephone | 864-582-2950
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JENNIFER WREN LEVER
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Credential | DMD
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Telephone | 864-621-5366
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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 | 3632
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License Number State | SC
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