MEDICARE: BEREA COMPREHENSIVE DENTISTRY

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	122300000X	Dentist	2881	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972650042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEREA COMPREHENSIVE DENTISTRY

Provider Business Mailing Address
First Line	:	701 SULPHUR SPRINGS RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-1913
Country	:	US
Telephone Number	:	864-246-2181
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 SULPHUR SPRINGS RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-1913
Country	:	US
Telephone Number	:	864-246-2181
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MIR JIM NASIM
Credential	:	DMD
Telephone Number	:	864-246-2181

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/22/2020

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Directions to “BEREA COMPREHENSIVE DENTISTRY ” Practice Location

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