Healthcare Provider Details

I. General information

NPI: 1336348390
Provider Name (Legal Business Name): DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W. MEETING ST SUITE 100
LANCASTER SC
29720
US

IV. Provider business mailing address

1025 W. MEETING ST. SUITE 100
LANCASTER SC
29720
US

V. Phone/Fax

Practice location:
  • Phone: 803-286-6533
  • Fax: 803-286-8776
Mailing address:
  • Phone: 803-286-6533
  • Fax: 803-286-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2606
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2606
License Number StateSC

VIII. Authorized Official

Name: BRITTANY N HOWARD
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-8946