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General NPI Number Information
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NPI Number | 1780176412
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Entity Type | Organization
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Legal Business Name | PALMETTO SMILES OF FLORENCE PA
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 1260 CELEBRATION BLVD
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City | FLORENCE
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State | SC
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Zip | 29501-5498
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Country | US
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Telephone | 843-669-5687
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 CELEBRATION BLVD
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City | FLORENCE
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State | SC
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Zip | 29501-5498
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Country | US
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Telephone | 843-669-5687
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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. BRIAN E SANG
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Credential | DDS
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Telephone | 843-669-5687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | SC6922
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License Number State | SC
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