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General NPI Number Information
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NPI Number | 1144974031
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Entity Type | Organization
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Legal Business Name | SS DENTAL LLC
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1116 ATLAS RD
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City | COLUMBIA
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State | SC
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Zip | 29209-2532
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Country | US
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Telephone | 803-783-0525
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Fax | 803-776-1105
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Provider Business Mailing Address
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Address Line | 1116 ATLAS RD
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City | COLUMBIA
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State | SC
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Zip | 29209-2532
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Country | US
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Telephone | 803-783-0525
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Fax | 803-776-1105
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Authorized Official
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Title or Position | DR./OWNER
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Name | DR. JON D. SMITH
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Credential | DDS
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Telephone | 803-606-5134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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