MEDICARE: CARL B FREEDMAN,DDS, RHEA W RICHARDSON,DMD, 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	1223G0001X	General Practice Dentistry	1825	SC

General Provider Information

NPI Number	:	1518070846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL B FREEDMAN,DDS, RHEA W RICHARDSON,DMD, LLC

Provider Business Mailing Address
First Line	:	6420 GARNERS FERRY RD
Second Line	:	SUITE X
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1632
Country	:	US
Telephone Number	:	803-776-4234
Fax Number	:	803-776-4900

Provider Business Practice Location Address
First Line	:	6420 GARNERS FERRY RD
Second Line	:	SUITE X
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1632
Country	:	US
Telephone Number	:	803-776-4234
Fax Number	:	803-776-4900

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. RHEA WALTERS RICHARDSON
Credential	:	DMD
Telephone Number	:	803-776-4234

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	08/22/2020

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