Provider Demographics
NPI:1205859568
Name:ASIS, ENCARNITA SALVADOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ENCARNITA
Middle Name:SALVADOR
Last Name:ASIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:ENCARNITA
Other - Middle Name:
Other - Last Name:SALVADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5540 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9262
Mailing Address - Country:US
Mailing Address - Phone:803-358-0403
Mailing Address - Fax:803-957-0762
Practice Address - Street 1:5540 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-358-0403
Practice Address - Fax:803-957-0762
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC38281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3828Medicaid