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NPI Code Detail

MEDICARE: BLUE RIDGE DENTAL LLC

MEDICARE: BLUE RIDGE DENTAL 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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1427766823
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE RIDGE DENTAL LLC
Provider Business Mailing Address
First Line : 2224 OLD FURNACE RD
Second Line :
City : BOILING SPRINGS
State : SC
Zip : 29316-5782
Country : US
Telephone Number : 864-586-5050
Fax Number :
Provider Business Practice Location Address
First Line : 2224 OLD FURNACE RD
Second Line :
City : BOILING SPRINGS
State : SC
Zip : 29316-5782
Country : US
Telephone Number : 864-586-5050
Fax Number :
Authorized Official
Title or Position : PROVIDER
Name : DR. ALEKSEY ZELENKO
Credential : DMD
Telephone Number : 864-580-8767
Provider Enumeration Date : 11/14/2022
Last Update Date : 11/14/2022

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Directions to “BLUE RIDGE DENTAL LLC ” Practice Location

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