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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