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General NPI Number Information
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NPI Number | 1578701629
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Entity Type | Organization
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Legal Business Name | SONRISAS HERMOSAS
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 01/28/2009
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Provider Practice Location Address
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Address Line | 4501 OLD SPARTANBURG RD STE 3
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City | TAYLORS
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State | SC
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Zip | 29687-4105
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Country | US
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Telephone | 864-268-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 4501 OLD SPARTANBURG RD STE 3
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City | TAYLORS
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State | SC
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Zip | 29687-4105
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Country | US
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Telephone | 864-268-2011
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Fax |
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Authorized Official
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Title or Position | DENTIST/MANAGER
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Name | DR. BOBBY MONROE SAFRIT II
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Credential | D.M.D
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Telephone | 864-268-2011
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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 | 4138
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License Number State | SC
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