Healthcare Provider Details

I. General information

NPI: 1609524644
Provider Name (Legal Business Name): DRS RONCAGLIONE AND REIMELS COLUMBIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 ELMTREE RD
COLUMBIA SC
29209-2614
US

IV. Provider business mailing address

PO BOX 2249
HUNTERSVILLE NC
28070-2249
US

V. Phone/Fax

Practice location:
  • Phone: 803-783-9900
  • Fax:
Mailing address:
  • Phone: 704-978-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AMANDA NOELLE GROESCHEL
Title or Position: DIRECTOR
Credential:
Phone: 704-978-9800