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General NPI Number Information
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NPI Number | 1528112398
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Entity Type | Organization
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Legal Business Name | CAROLINA CHILDREN'S DENTISTRY, LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 500 PHYSICIANS LN
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City | SUMTER
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State | SC
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Zip | 29150-3370
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Country | US
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Telephone | 803-775-4793
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Fax | 803-934-9943
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Provider Business Mailing Address
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Address Line | 500 PHYSICIANS LN
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City | SUMTER
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State | SC
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Zip | 29150-3370
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Country | US
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Telephone | 803-775-4793
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Fax | 803-934-9943
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Authorized Official
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Title or Position | OWNER
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Name | DR. FELICIA L GOINS
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Credential | D.D.S
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Telephone | 803-775-4793
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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 |
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License Number State |
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