MEDICARE: FAMILY DENTAL HEALTH GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1104778869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DENTAL HEALTH GROUP LLC

Provider Business Mailing Address
First Line	:	400 MEMORIAL DRIVE EXT STE 400
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29651-1850
Country	:	US
Telephone Number	:	864-282-1935
Fax Number	:	864-751-6387

Provider Business Practice Location Address
First Line	:	2138 HIGHWAY 41
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-6201
Country	:	US
Telephone Number	:	843-972-5587
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF INSURANCE
Name	:	MRS. BETH LOUISE ILLSLEY
Credential	:	N/A
Telephone Number	:	864-282-1935

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

Similar Medicare Providers

1104414770 — DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Practice Location Address:

2138 HIGHWAY 41
MOUNT PLEASANT, SC
29466-6201

Practice Phone: 843-606-5408
Practice Fax:

1285380485 — DAMIAN JASIK DDS
Practice Location Address:

2138 HIGHWAY 41
MOUNT PLEASANT, SC
29466-6201

Practice Phone: 843-654-1857
Practice Fax:

1366175390 — CHRISTIAN EDWARDS
Practice Location Address:

2138 HIGHWAY 41
MOUNT PLEASANT, SC
29466-6201

Practice Phone: 843-972-5587
Practice Fax:

1750653820 — DR. TRIFON DALKALITSIS M. D.
Practice Location Address:

2565 S PLEASANT PT
INVERNESS, FL
34450-6201

Practice Phone: 352-726-3828
Practice Fax: 352-726-3828

1619359627 — DR. DEBRA GANDY ADAMS DMD
Practice Location Address:

2053 ARUNDEL PL
MT PLEASANT, SC
29464-6201

Practice Phone: 843-225-3353
Practice Fax:

1871826685 — KATHLEEN ROSE PT
Practice Location Address:

550 BURNETT RD
MOUNT JULIET, TN
37122-6201

Practice Phone: 615-533-6659
Practice Fax:

Directions to “FAMILY DENTAL HEALTH GROUP LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.