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General NPI Number Information
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NPI Number | 1376955351
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Entity Type | Organization
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Legal Business Name | DENTISTRY FOR CHILDREN OF SOUTH CAROLINA PC
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 1767 S LAKE DR STE A
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City | LEXINGTON
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State | SC
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Zip | 29073-6734
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Country | US
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Telephone | 404-389-1950
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Fax |
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Provider Business Mailing Address
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Address Line | 2970 BRANDYWINE RD STE 200
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City | ATLANTA
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State | GA
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Zip | 30341-5549
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Country | US
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Telephone | 770-692-1000
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | JO ANN RICE
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Credential |
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Telephone | 470-881-8679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN013607
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License Number State | GA
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