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General NPI Number Information
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NPI Number | 1497146906
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Entity Type | Organization
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Legal Business Name | PALMETTO PROSTHODONTICS, LLC
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 145 WOODRUFF PLACE CIR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3672
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Country | US
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Telephone | 864-757-9433
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Fax |
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Provider Business Mailing Address
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Address Line | 145 WOODRUFF PLACE CIR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3672
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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 | PRESIDENT
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Name | DR. JASON MINTON
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Credential | DMD
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Telephone | 864-757-9433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 7043
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License Number State | SC
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