Provider Demographics
NPI:1447604723
Name:JIM NASIM DMD PA
Entity type:Organization
Organization Name:JIM NASIM DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-229-6639
Mailing Address - Street 1:101 DURST AVE W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-2020
Mailing Address - Country:US
Mailing Address - Phone:864-229-6639
Mailing Address - Fax:864-941-3319
Practice Address - Street 1:101 DURST AVE W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-2020
Practice Address - Country:US
Practice Address - Phone:864-229-6639
Practice Address - Fax:864-941-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty