Healthcare Provider Details

I. General information

NPI: 1932895240
Provider Name (Legal Business Name): MITCHELL PIACSEK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 2ND LOOP RD
FLORENCE SC
29505-2841
US

IV. Provider business mailing address

1343 2ND LOOP RD
FLORENCE SC
29505-2841
US

V. Phone/Fax

Practice location:
  • Phone: 843-665-8176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDGD.10722
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDGD.11415
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6001411-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: