Provider Demographics
NPI:1861886038
Name:CONSTANTINE DENTAL PA
Entity type:Organization
Organization Name:CONSTANTINE DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CONSTANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-387-9748
Mailing Address - Street 1:1 W PRENTISS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4029
Mailing Address - Country:US
Mailing Address - Phone:864-607-8848
Mailing Address - Fax:
Practice Address - Street 1:1 W PRENTISS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4029
Practice Address - Country:US
Practice Address - Phone:864-607-8848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty