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NPI Code Detail

MEDICARE: WHITE KNOLL COMPREHENSIVE DENTISTRY

MEDICARE: WHITE KNOLL COMPREHENSIVE DENTISTRY
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
1122300000XDentist2790SC

General Provider Information

NPI Number : 1811361579
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHITE KNOLL COMPREHENSIVE DENTISTRY
Provider Business Mailing Address
First Line : 1825 S LAKE DR
Second Line :
City : LEXINGTON
State : SC
Zip : 29073-7759
Country : US
Telephone Number : 803-785-9991
Fax Number : 803-785-6921
Provider Business Practice Location Address
First Line : 1825 S LAKE DR
Second Line :
City : LEXINGTON
State : SC
Zip : 29073-7759
Country : US
Telephone Number : 803-785-9991
Fax Number : 803-785-6921
Authorized Official
Title or Position : INSURANCE COORDINATOR
Name : MRS. PAMELA SUZANNE COCKRELL
Credential :
Telephone Number : 803-785-9991
Provider Enumeration Date : 11/18/2015
Last Update Date : 11/18/2015

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Directions to “WHITE KNOLL COMPREHENSIVE DENTISTRY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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