Healthcare Provider Details

I. General information

NPI: 1114287042
Provider Name (Legal Business Name): GOLD HILL DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 PLEASANT RD SUITE 104
FORT MILL SC
29708-9215
US

IV. Provider business mailing address

2848 PLEASANT RD SUITE 104
FORT MILL SC
29708-9215
US

V. Phone/Fax

Practice location:
  • Phone: 803-547-4466
  • Fax: 803-547-4660
Mailing address:
  • Phone: 803-547-4466
  • Fax: 803-547-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4692
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4692
License Number StateSC

VIII. Authorized Official

Name: KAVI SAGUNARTHY
Title or Position: OWNER/PRESIDENT
Credential: D.D.S.
Phone: 803-547-4466