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General NPI Number Information
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NPI Number | 1598830697
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Entity Type | Organization
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Legal Business Name | ORAL SURGERY ASSOCIATES,PA
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 ENTERPRISE BLVD STE 209
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City | GREENVILLE
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State | SC
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Zip | 29615-3554
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Country | US
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Telephone | 864-234-8811
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Fax | 864-234-8844
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Provider Business Mailing Address
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Address Line | 10 ENTERPRISE BLVD STE 209
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City | GREENVILLE
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State | SC
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Zip | 29615-3554
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Country | US
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Telephone | 864-234-8811
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Fax | 864-234-8844
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK H. HANCOCK
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Credential | DMD
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Telephone | 864-234-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 1588
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License Number State | SC
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