Provider Demographics
NPI:1275742165
Name:MID CAROLINA DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:MID CAROLINA DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-285-7645
Mailing Address - Street 1:1012 N WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-1966
Mailing Address - Country:US
Mailing Address - Phone:803-285-7645
Mailing Address - Fax:803-285-7687
Practice Address - Street 1:1012 N WOODLAND DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-1966
Practice Address - Country:US
Practice Address - Phone:803-285-7645
Practice Address - Fax:803-285-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
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
SC92948Medicaid