Healthcare Provider Details

I. General information

NPI: 1538937453
Provider Name (Legal Business Name): PALMETTO ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W MAIN ST
LEXINGTON SC
29072-2636
US

IV. Provider business mailing address

4023 FOREST DR
COLUMBIA SC
29204-4313
US

V. Phone/Fax

Practice location:
  • Phone: 803-782-7722
  • Fax:
Mailing address:
  • Phone: 803-782-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD BARRETT
Title or Position: OWNER
Credential: DMD
Phone: 803-782-7722