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General NPI Number Information
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NPI Number | 1477417509
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL HEALTH GROUP LLC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 700 PLAZA CIR STE M
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City | CLINTON
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State | SC
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Zip | 29325-7556
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Country | US
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Telephone | 864-833-5673
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Fax |
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Provider Business Mailing Address
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Address Line | 400 MEMORIAL DRIVE EXT STE 400
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City | GREER
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State | SC
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Zip | 29651-1850
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Country | US
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Telephone | 864-282-1935
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Fax | 864-751-6387
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Authorized Official
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Title or Position | DIRECTOR OF INSURANCE
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Name | MRS. BETH LOUISE ILLSLEY
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Credential | N/A
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Telephone | 864-282-1935
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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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