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General NPI Number Information
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NPI Number | 1124635495
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Entity Type | Organization
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Legal Business Name | DESTINATION DENTAL OF DUNCAN LLC
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 155 DEACON TILLER CT
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City | DUNCAN
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State | SC
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Zip | 29334-8880
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Country | US
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Telephone | 864-485-2214
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Fax | 864-485-2215
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Provider Business Mailing Address
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Address Line | 401 COMMERCE DR STE 108
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-2724
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Country | US
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Telephone | 215-550-4590
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Fax | 215-646-6166
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Authorized Official
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Title or Position | OWNER
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Name | DR. NIRANJAN SAVANI
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Credential | DMD
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Telephone | 215-550-4590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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