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NPI Code Detail

MEDICARE: MID CAROLINA DENTAL CENTER PLLC

MEDICARE: MID CAROLINA DENTAL CENTER PLLC
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
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275742165
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID CAROLINA DENTAL CENTER PLLC
Provider Business Mailing Address
First Line : 1012 N WOODLAND DR
Second Line :
City : LANCASTER
State : SC
Zip : 29720-1966
Country : US
Telephone Number : 803-285-7645
Fax Number : 803-285-7687
Provider Business Practice Location Address
First Line : 1012 N WOODLAND DR
Second Line :
City : LANCASTER
State : SC
Zip : 29720-1966
Country : US
Telephone Number : 803-285-7645
Fax Number : 803-285-7687
Authorized Official
Title or Position : PRESIDENT DENTIST
Name : DR. MINDY RENEE GOINS
Credential : D.D.S.
Telephone Number : 803-285-7645
Provider Enumeration Date : 05/21/2007
Last Update Date : 08/22/2020

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Directions to “MID CAROLINA DENTAL CENTER PLLC ” Practice Location

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