MEDICARE: DENTAL DESIGNS LLC

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	3609	SC

General Provider Information

NPI Number	:	1417332420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL DESIGNS LLC

Provider Business Mailing Address
First Line	:	3101 BOILING SPRINGS RD
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-6016
Country	:	US
Telephone Number	:	864-578-9366
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 BOILING SPRINGS RD
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-6016
Country	:	US
Telephone Number	:	864-578-9366
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DEBORAH DUCKETT
Credential	:
Telephone Number	:	864-380-8150

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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