MEDICARE: DENTISTRY FOR CHILDREN OF SOUTH CAROLINA PC

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	1223P0221X	Pediatric Dentistry	DN13607	GA

General Provider Information

NPI Number	:	1952713927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTRY FOR CHILDREN OF SOUTH CAROLINA PC

Provider Business Mailing Address
First Line	:	2970 BRANDYWINE RD STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5549
Country	:	US
Telephone Number	:	770-692-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 N LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2833
Country	:	US
Telephone Number	:	404-389-1950
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	JO ANN RICE
Credential	:
Telephone Number	:	470-881-8679

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	11/28/2025

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