MEDICARE: PALMETTO DENTAL HEALTH ASSOCIATES 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	3114	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1821077751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO DENTAL HEALTH ASSOCIATES PA

Provider Business Mailing Address
First Line	:	103 EAST TATUM AVENUE
Second Line	:
City	:	MCCOLL
State	:	SC
Zip	:	29570-2323
Country	:	US
Telephone Number	:	843-523-5291
Fax Number	:	843-523-9714

Provider Business Practice Location Address
First Line	:	103 EAST TATUM AVENUE
Second Line	:
City	:	MCCOLL
State	:	SC
Zip	:	29570-2323
Country	:	US
Telephone Number	:	843-523-5291
Fax Number	:	843-523-9714

Authorized Official
Title or Position	:	CO OWNER DENTIST
Name	:	DR. KEVIN ALLEN JASINSKI
Credential	:	DMD
Telephone Number	:	843-523-5291

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	08/22/2020

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Practice Location Address:

103 EAST TATUM AVENUE
MCCOLL, SC
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1427032424 — PHILIP LIN BENTON DMD
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1467438846 — DR. TERRY ANNE GUTKNECHT SAMS DMD
Practice Location Address:

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Practice Location Address:

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1861723199 — RIGHT PATH HOME CARE
Practice Location Address:

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