Provider Demographics
NPI:1215552997
Name:PALMETTO FAMILY AND COSMETIC DENTISTRY III
Entity Type:Organization
Organization Name:PALMETTO FAMILY AND COSMETIC DENTISTRY III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-469-3555
Mailing Address - Street 1:2590 TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1860
Mailing Address - Country:US
Mailing Address - Phone:803-469-3555
Mailing Address - Fax:
Practice Address - Street 1:1211 GREENLAWN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2631
Practice Address - Country:US
Practice Address - Phone:803-783-1198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty