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General NPI Number Information
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NPI Number | 1164843918
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Entity Type | Organization
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Legal Business Name | PALMETTO KIDS DENTISTRY
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 04/11/2014
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Provider Practice Location Address
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Address Line | 101 PATRIOT LANE
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City | SUMMERVILLE
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State | SC
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Zip | 29483
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Country | US
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Telephone | 843-478-1739
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Fax |
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Provider Business Mailing Address
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Address Line | 101 PATRIOT LANE
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City | SUMMERVILLE
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State | SC
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Zip | 29483
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Country | US
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Telephone | 843-284-6497
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLY DUFFEY
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Credential | DMD
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Telephone | 843-284-6497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4352
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License Number State | SC
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