Healthcare Provider Details

I. General information

NPI: 1306891833
Provider Name (Legal Business Name): FELICIA L. GOINS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 TRENHOLM ROAD EXT
COLUMBIA SC
29223-1725
US

IV. Provider business mailing address

7701 TRENHOLM ROAD EXT
COLUMBIA SC
29223-1725
US

V. Phone/Fax

Practice location:
  • Phone: 803-736-6000
  • Fax: 803-736-6084
Mailing address:
  • Phone: 803-736-6000
  • Fax: 803-736-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2719-333PD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: