=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457978207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DASH DENTAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2020
-----------------------------------------------------
Last Update Date | 06/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 BUSINESS PKWY STE D
-----------------------------------------------------
City | GREER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29651-7118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-561-4194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 W SCENIC DR
-----------------------------------------------------
City | TRAVELERS REST
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29690-9563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-561-4194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DANIEL ASHTON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 864-561-4194
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------