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General NPI Number Information
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NPI Number | 1215552997
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Entity Type | Organization
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Legal Business Name | PALMETTO FAMILY AND COSMETIC DENTISTRY III
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 1211 GREENLAWN DR
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City | COLUMBIA
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State | SC
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Zip | 29209-2631
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Country | US
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Telephone | 803-783-1198
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Fax |
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Provider Business Mailing Address
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Address Line | 2590 TAHOE DR
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City | SUMTER
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State | SC
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Zip | 29150-1860
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Country | US
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Telephone | 803-469-3555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM THOMAS NOONAN
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Credential |
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Telephone | 803-469-3555
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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 |
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License Number State |
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