Healthcare Provider Details

I. General information

NPI: 1558160945
Provider Name (Legal Business Name): CAMDEN PEDIATRIC DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 WALL ST APT 405
CAMDEN SC
29020-8061
US

IV. Provider business mailing address

7701 TRENHOLM ROAD EXT
COLUMBIA SC
29223-1725
US

V. Phone/Fax

Practice location:
  • Phone: 803-306-8847
  • Fax: 803-615-4294
Mailing address:
  • Phone: 803-306-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BYUNGDO BRIAN HAN
Title or Position: OWNER / DENTIST
Credential: DDS, PHD
Phone: 803-306-8847