Provider Demographics
NPI:1902167307
Name:SPARTANBURG ENDODONTIC ASSOCIATES PA
Entity Type:Organization
Organization Name:SPARTANBURG ENDODONTIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-SPARTANBURG ENDODONTIC AS
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-582-0332
Mailing Address - Street 1:154 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-3364
Mailing Address - Country:US
Mailing Address - Phone:864-582-0332
Mailing Address - Fax:864-582-2263
Practice Address - Street 1:154 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-3364
Practice Address - Country:US
Practice Address - Phone:864-582-0332
Practice Address - Fax:864-582-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty