Organization
ORAL SURGERY ASSOCIATES,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK H. HANCOCK DMD (PRESIDENT)
(864) 234-8811
Entity
Organization
Contact information
Practice address
10 ENTERPRISE BLVD STE 209, GREENVILLE, SC 29615-3554
(864) 234-8811
(864) 234-8844
Mailing address
10 ENTERPRISE BLVD STE 209, GREENVILLE, SC 29615-3554
(864) 234-8811
(864) 234-8844
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
1588
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001588
DELTA SC PROVIDER
SC
01
—
115
SPECIALTY
SC
01
—
1588
LICENSE
SC
01
—
AH5385732
BNDD#
SC
05
—
Z15889
—
SC
Enumeration date
11/22/2006
Last updated
08/22/2020
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