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Organization
BELLA VISTA FAMILY DENTAL AT FIVE FORKS
Active
Organization
BELLA VISTA FAMILY DENTAL AT FIVE FORKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN KENNEDY JR. DMD (OWNER)
(864) 501-0070
Entity
Organization
Contact information
Practice address
2311 WOODRUFF RD, SIMPSONVILLE, SC 29681-5442
(864) 501-9800
Mailing address
PO BOX 31625, GREENVILLE, SC 29608-1625
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4377
SC
1223G0001X
General Practice Dentistry
Primary
4377
SC
Other
Enumeration date
03/16/2018
Last updated
03/16/2018
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