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General NPI Number Information
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NPI Number | 1750919718
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Entity Type | Organization
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Legal Business Name | DESTINATION DENTAL LLC
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 155 DEACON TILLER CT STE 101
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City | DUNCAN
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State | SC
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Zip | 29334-8880
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Country | US
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Telephone | 864-485-2214
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Fax | 864-485-2215
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Provider Business Mailing Address
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Address Line | 155 DEACON TILLER CT STE 101
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City | DUNCAN
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State | SC
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Zip | 29334-8880
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Country | US
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Telephone | 864-485-2214
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Fax | 864-485-2215
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. BLAKE JULIAN
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Credential | DDS
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Telephone | 864-485-2214
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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 |
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License Number State |
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