Healthcare Provider Details

I. General information

NPI: 1982468153
Provider Name (Legal Business Name): NEW KIDS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 OLD POINTE SCHOOL RD
ROCK HILL SC
29732-8978
US

IV. Provider business mailing address

316 OLD POINTE SCHOOL RD
ROCK HILL SC
29732-8978
US

V. Phone/Fax

Practice location:
  • Phone: 803-658-8604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: THU TRAN HO
Title or Position: DENTIST
Credential: DMD
Phone: 803-658-8604