Provider Demographics
NPI:1467470161
Name:DRS HOLT & DUENSING DENTAL CENTER PA
Entity Type:Organization
Organization Name:DRS HOLT & DUENSING DENTAL CENTER PA
Other - Org Name:JOHN W. HOLT, JIMMY A. DUENSING DENTAL CENTER, PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUENSING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-783-0694
Mailing Address - Street 1:8012 SUMTER HWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209
Mailing Address - Country:US
Mailing Address - Phone:803-783-0694
Mailing Address - Fax:803-783-7071
Practice Address - Street 1:8012 SUMTER HWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209
Practice Address - Country:US
Practice Address - Phone:803-783-0694
Practice Address - Fax:803-783-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ16331Medicaid
SCZ22592Medicaid