Provider Demographics
NPI:1417384405
Name:NDS II, LLC
Entity Type:Organization
Organization Name:NDS II, LLC
Other - Org Name:CAROLINA FOOTHILLS DENTAL- UNION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-427-0397
Mailing Address - Street 1:1000 E RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-1727
Mailing Address - Country:US
Mailing Address - Phone:843-757-2828
Mailing Address - Fax:843-757-0595
Practice Address - Street 1:216 S MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2331
Practice Address - Country:US
Practice Address - Phone:864-427-0397
Practice Address - Fax:864-427-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3451Medicaid