Provider Demographics
NPI:1437524469
Name:HILLCREST FAMILY AND COSMETIC DENTISTRY, LLC
Entity type:Organization
Organization Name:HILLCREST FAMILY AND COSMETIC DENTISTRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASPINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATTAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-582-4441
Mailing Address - Street 1:2088 E MAIN ST
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1425
Mailing Address - Country:US
Mailing Address - Phone:864-582-4441
Mailing Address - Fax:864-582-4489
Practice Address - Street 1:2088 E MAIN ST
Practice Address - Street 2:SUITE A & B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1425
Practice Address - Country:US
Practice Address - Phone:864-582-4441
Practice Address - Fax:864-582-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC47171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty