=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033346713
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCIA PINCKNEY COVINGTON DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2009
-----------------------------------------------------
Last Update Date | 01/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 637 BELLAMY AVE UNIT B
-----------------------------------------------------
City | MURRELLS INLET
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-947-0017
-----------------------------------------------------
Fax | 843-947-0668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 637 BELLAMY AVE UNIT B
-----------------------------------------------------
City | MURRELLS INLET
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-947-0017
-----------------------------------------------------
Fax | 843-947-0668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 4596
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------