Healthcare Provider Details

I. General information

NPI: 1609372440
Provider Name (Legal Business Name): TAWANA FEIMSTER, DDS, MS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 ADDISON DR STE 111
ROCK HILL SC
29730-7061
US

IV. Provider business mailing address

775 ADDISON DR STE 111
ROCK HILL SC
29730-7061
US

V. Phone/Fax

Practice location:
  • Phone: 980-316-7109
  • Fax: 980-939-0170
Mailing address:
  • Phone: 980-316-7109
  • Fax: 980-939-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number30833
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TAWANA D. FEIMSTER
Title or Position: OWNER
Credential: DDS, MS
Phone: 571-989-8634