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General NPI Number Information
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NPI Number | 1477792265
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Entity Type | Organization
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Legal Business Name | AT YOUR HOME DENTISTRY
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 810 DUTCH SQUARE BLVD SUITE 104
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City | COLUMBIA
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State | SC
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Zip | 29210-7318
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Country | US
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Telephone | 803-771-2600
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Fax | 516-665-5588
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Provider Business Mailing Address
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Address Line | 311 PLANTATION DR
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City | LEXINGTON
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State | SC
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Zip | 29072-7925
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Country | US
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Telephone | 803-771-2600
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Fax | 516-665-5588
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Authorized Official
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Title or Position | DENTIST
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Name | ANGELA MCFADDEN
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Credential | DMD
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Telephone | 803-771-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3177
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License Number State | SC
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