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Organization

R MATHIS 002 LLC

Active
Other names
Foothills Dental
Organization subpart
No

Provider details

NPI number
Authorized official
DALLAS BURNETT (CEO)
(864) 415-0931
Entity
Organization

Contact information

Practice address
2830 REIDVILLE RD, SPARTANBURG, SC 29301-5640
(864) 574-0762
Mailing address
230 N GROVE MEDICAL PARK DR, SPARTANBURG, SC 29303-4222
(864) 310-6888

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
11/19/2019
Last updated
11/04/2021
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