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General NPI Number Information
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NPI Number | 1912125782
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Entity Type | Organization
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Legal Business Name | NORTHEAST FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 7711 TRENHOLM ROAD EXTENSION
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City | COLUMBIA
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State | SC
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Zip | 29223-1725
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Country | US
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Telephone | 803-865-2602
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Fax | 803-865-1814
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Provider Business Mailing Address
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Address Line | 7711 TRENHOLM ROAD EXTENSION
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City | COLUMBIA
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State | SC
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Zip | 29223-1725
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Country | US
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Telephone | 803-865-2602
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Fax | 803-865-1814
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Authorized Official
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Title or Position | OWNER
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Name | DR. YOLANDA REID HUNTER
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Credential | DMD RN
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Telephone | 803-865-2602
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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 | 3015
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License Number State | SC
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