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General NPI Number Information
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NPI Number | 1578688875
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Entity Type | Organization
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Legal Business Name | FIVE FORKS DENTAL CARE, INC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 2833 WOODRUFF RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4807
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Country | US
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Telephone | 864-289-0289
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Fax |
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Provider Business Mailing Address
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Address Line | 2833 WOODRUFF RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4807
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Country | US
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Telephone | 864-289-0289
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRISTINA LYNN HAPNEY
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Credential | DMD
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Telephone | 864-289-0289
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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 | 4144
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License Number State | SC
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