MEDICARE: PREMIER ENDODONTICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	3190	SC

General Provider Information

NPI Number	:	1629113816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ENDODONTICS PC

Provider Business Mailing Address
First Line	:	7024 BROOKFIELD RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2211
Country	:	US
Telephone Number	:	803-419-1327
Fax Number	:	803-419-2974

Provider Business Practice Location Address
First Line	:	7024 BROOKFIELD RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2211
Country	:	US
Telephone Number	:	803-419-1327
Fax Number	:	803-419-2974

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRED L. SYKES
Credential	:	DDS
Telephone Number	:	803-419-1327

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/22/2020

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