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Organization
PRIME DENTAL LLC
Active
Organization
PRIME DENTAL LLC
Active
Parent organization
PRIME DENTAL LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRIME DENTAL LLC
Authorized official
ASA DUNCAN SHIRLEY DMD (OWNER/DENTIST)
(864) 332-1266
Entity
Organization
Contact information
Practice address
4130 CLEMSON BLVD, ANDERSON, SC 29621
(864) 332-1266
(864) 261-6988
Mailing address
4130 CLEMSON BLVD, ANDERSON, SC 29621
(864) 332-1266
(864) 332-1266
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218632
—
SC
01
—
ZZ2657
-
SC
Enumeration date
07/17/2019
Last updated
07/17/2019
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