Provider Demographics
NPI:1083834972
Name:DENTAL ACCESS CAROLINA, LLC
Entity Type:Organization
Organization Name:DENTAL ACCESS CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:REESE
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-324-3101
Mailing Address - Street 1:PO BOX 11804
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-1804
Mailing Address - Country:US
Mailing Address - Phone:803-324-3101
Mailing Address - Fax:803-324-3101
Practice Address - Street 1:454 S. ANDERSON RD
Practice Address - Street 2:SUITE 126
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730
Practice Address - Country:US
Practice Address - Phone:803-324-3101
Practice Address - Fax:803-324-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9620Medicaid