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General NPI Number Information
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NPI Number | 1730343435
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Entity Type | Organization
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Legal Business Name | SHINDA LLC
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 943 JOHN C CALHOUN DR
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City | ORANGEBURG
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State | SC
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Zip | 29115
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Country | US
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Telephone | 803-662-9398
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Fax |
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Provider Business Mailing Address
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Address Line | 943 JOHN C CALHOUN DR
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City | ORANGEBURG
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State | SC
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Zip | 29115-6763
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Country | US
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Telephone | 803-937-4128
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Fax | 880-937-4128
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DWIGHT MCMILLAN JR.
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Credential | DDS
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Telephone | 803-531-0750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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