MEDICARE: THE ORTHODONTIC CENTER

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	SC1315	SC

General Provider Information

NPI Number	:	1740408368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ORTHODONTIC CENTER

Provider Business Mailing Address
First Line	:	9600 TWO NOTCH RD
Second Line	:	SUITE 22
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4304
Country	:	US
Telephone Number	:	803-736-1330
Fax Number	:	803-736-1361

Provider Business Practice Location Address
First Line	:	9600 TWO NOTCH RD
Second Line	:	SUITE 22
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4304
Country	:	US
Telephone Number	:	803-736-1330
Fax Number	:	803-736-1361

Authorized Official
Title or Position	:	OWNER
Name	:	CURTISS W DAUGHTRY
Credential	:	DDS
Telephone Number	:	803-736-1330

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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Directions to “THE ORTHODONTIC CENTER ” Practice Location

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