MEDICARE: COOMBS FAMILY ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1942159439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOMBS FAMILY ORTHODONTICS

Provider Business Mailing Address
First Line	:	747 JULIA ST
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6409
Country	:	US
Telephone Number	:	803-493-5109
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 INDIA HOOK RD STE 201
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3530
Country	:	US
Telephone Number	:	803-493-5109
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SPENCER COOMBS
Credential	:	DMD
Telephone Number	:	803-493-5109

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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