Healthcare Provider Details

I. General information

NPI: 1376955351
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN OF SOUTH CAROLINA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1767 S LAKE DR STE A
LEXINGTON SC
29073-6734
US

IV. Provider business mailing address

2970 BRANDYWINE RD STE 200
ATLANTA GA
30341-5549
US

V. Phone/Fax

Practice location:
  • Phone: 404-389-1950
  • Fax:
Mailing address:
  • Phone: 770-692-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN013607
License Number StateGA

VIII. Authorized Official

Name: JO ANN RICE
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 470-881-8679