Family Dental Health of Moore LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FAMILY DENTAL HEALTH OF MOORE LLC

Practice address

4044 Moore Duncan Hwy
Moore, SC 29369-9774

Phone

(864) 203-8540

Fax

(864) 751-6387

NPI assigned

Aug 18, 2021

Last updated

Jan 9, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

FDH HOLDINGS LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Beth Illsley

Title

Director of Insurance

Phone

(864) 282-1935

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Devan Scott Bolf, DMD

  • Dentist
  • Mauldin, SC
  • NPI 1245685791
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1659047801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MEMORIAL DRIVE EXT STE 400",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296511850",
            "telephone_number": "864-282-1935",
            "fax_number": "864-751-6387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4044 MOORE DUNCAN HWY",
            "city": "MOORE",
            "state": "SC",
            "postal_code": "293699774",
            "telephone_number": "864-203-8540",
            "fax_number": "864-751-6387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL HEALTH OF MOORE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FDH HOLDINGS LLC",
        "enumeration_date": "2021-08-18",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "ILLSLEY",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "DIRECTOR OF INSURANCE",
        "authorized_official_telephone_number": "864-282-1935",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily D Crocker, RN
• Jordan Thomas Dunning, PHARM.D.
• Barry Anthony Earle, RPH
• Kia Edwards
• Mark Egan, COTA/L
• Tara Ferris
• Andrew Earl Floyd Jr., D.M.D.
• Fusion Trucking LLC Dba Fusion Transportation
• Nicole Gardy
• Akash Garg, D.C.

• General Practice Dentistry in Moore, SC
• Providers in Moore, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.