Organization
EASLEY DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIR JIM NASIM (OWNER)
(864) 306-0800
Entity
Organization
Contact information
Practice address
1040 S PENDLETON ST STE C, EASLEY, SC 29642-1047
(864) 306-0800
Mailing address
1040 S PENDLETON ST STE C, EASLEY, SC 29642-1047
(864) 306-0800
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX3245
—
SC
Enumeration date
05/02/2012
Last updated
05/02/2012
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