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General NPI Number Information
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NPI Number | 1396532438
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Entity Type | Organization
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Legal Business Name | THE PEDIATRIC SMILE ACADEMY
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 1707 BERNARDIN AVE
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City | COLUMBIA
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State | SC
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Zip | 29204-2004
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Country | US
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Telephone | 803-470-1121
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Fax |
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Provider Business Mailing Address
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Address Line | 5965 TOKEN ST
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City | COLUMBIA
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State | SC
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Zip | 29203-4839
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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 | PEDIATRIC DENTIST
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Name | DR. DARREN ALLEN THOMPSON
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Credential | DDS
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Telephone | 803-546-4736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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