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General NPI Number Information
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NPI Number | 1396445508
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Entity Type | Organization
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Legal Business Name | POUGH DENTISTRY
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 3126 DEVINE ST
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City | COLUMBIA
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State | SC
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Zip | 29205-1846
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Country | US
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Telephone | 803-252-8101
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Fax | 803-779-7721
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Provider Business Mailing Address
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Address Line | 276 TUFTON CT
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City | CAYCE
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State | SC
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Zip | 29033-2742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. MAKEEBA BOOKHART POUGH
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Credential | DMD
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Telephone | 803-260-0807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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