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General NPI Number Information
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NPI Number | 1841667037
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Entity Type | Organization
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Legal Business Name | MIDLANDS PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 253 CEDARCREST DR
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City | LEXINGTON
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State | SC
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Zip | 29072-3812
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Country | US
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Telephone | 803-951-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 221 SPRINGS CT
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City | WEST COLUMBIA
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State | SC
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Zip | 29170-2474
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Country | US
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Telephone | 803-951-7337
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ROBERT LAFORREST SHOUN
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Credential | DMD
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Telephone | 803-348-8976
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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 | 3801
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License Number State | SC
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