Healthcare Provider Details

I. General information

NPI: 1801938568
Provider Name (Legal Business Name): PALMETTO ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 FOREST DR
COLUMBIA SC
29204-4313
US

IV. Provider business mailing address

4023 FOREST DR
COLUMBIA SC
29204-4313
US

V. Phone/Fax

Practice location:
  • Phone: 803-782-7722
  • Fax: 803-782-4573
Mailing address:
  • Phone: 803-782-7722
  • Fax: 803-782-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberSC3675
License Number StateSC

VIII. Authorized Official

Name: DR. TODD R BARRETT
Title or Position: ENDODONTIST
Credential: DMD
Phone: 803-782-7722