Healthcare Provider Details

I. General information

NPI: 1841478146
Provider Name (Legal Business Name): SANDHILLS COMMUNITY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S SEVENTH ST
MC BEE SC
29101-7101
US

IV. Provider business mailing address

645 S SEVENTH ST
MC BEE SC
29101-7101
US

V. Phone/Fax

Practice location:
  • Phone: 843-680-0813
  • Fax: 843-335-6309
Mailing address:
  • Phone: 843-680-0813
  • Fax: 843-335-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberZA9427
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberZA9427
License Number StateSC

VIII. Authorized Official

Name: TERESA A FERGUSON
Title or Position: RECEPTIONIST
Credential:
Phone: 843-680-0813