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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