Healthcare Provider Details

I. General information

NPI: 1164304986
Provider Name (Legal Business Name): PREMIER SMILE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7212 BROOKFIELD RD
COLUMBIA SC
29223-2202
US

IV. Provider business mailing address

7212 BROOKFIELD RD
COLUMBIA SC
29223-2202
US

V. Phone/Fax

Practice location:
  • Phone: 803-626-1265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GLENNELL SMITH
Title or Position: DENTIST
Credential: DDS
Phone: 803-626-1265