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General NPI Number Information
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NPI Number | 1689088676
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Entity Type | Organization
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Legal Business Name | PAGELAND DENTISTRY PA
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 124 S PEARL ST
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City | PAGELAND
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State | SC
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Zip | 29728-2254
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Country | US
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Telephone | 843-672-2403
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Fax | 843-672-3299
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Provider Business Mailing Address
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Address Line | 124 S PEARL ST
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City | PAGELAND
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State | SC
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Zip | 29728-2254
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Country | US
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Telephone | 843-672-2403
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Fax | 843-672-3299
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MRS. ANASTASIA V VORONINA
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Credential | DDS
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Telephone | 843-672-2403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 4435
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License Number State | SC
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