=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376438036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTIST IN WEST COLUMBIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2025
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3935 SUNSET BLVD STE C
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29169-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-830-6881
-----------------------------------------------------
Fax | 803-756-4346
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3935 SUNSET BLVD STE C
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29169-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-830-6881
-----------------------------------------------------
Fax | 803-756-4346
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SUNIL R EAMANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-830-6881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------