Healthcare Provider Details

I. General information

NPI: 1396899175
Provider Name (Legal Business Name): CAROLINA CHILDREN'S DENTISTRY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/25/2012
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:
Mailing address:
  • Phone: 803-736-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. FELICIA L GOINS
Title or Position: OWNER
Credential: D.D.S
Phone: 803-736-6000