=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265686018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAMAN FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2008
-----------------------------------------------------
Last Update Date | 11/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5945 WESCOTT RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29212-2717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-781-2930
-----------------------------------------------------
Fax | 803-781-8566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5945 WESCOTT ROAD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-781-2930
-----------------------------------------------------
Fax | 803-781-8566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. MISTI S RAMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-781-2930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4141
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------