MEDICARE: TRINITY ENDODONTICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3203	SC
2	1223E0200X	Endodontics	463	SC

General Provider Information

NPI Number	:	1154407930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY ENDODONTICS PA

Provider Business Mailing Address
First Line	:	PO BOX 529
Second Line	:
City	:	SANTEE
State	:	SC
Zip	:	29142-0529
Country	:	US
Telephone Number	:	803-854-2431
Fax Number	:

Provider Business Practice Location Address
First Line	:	627 BASS DRIVE
Second Line	:
City	:	SANTEE
State	:	SC
Zip	:	29142-0529
Country	:	US
Telephone Number	:	803-854-2431
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MELANIE ANNE BROWN
Credential	:	DMD
Telephone Number	:	803-854-2431

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	01/26/2011

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Directions to “TRINITY ENDODONTICS PA ” Practice Location

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