Provider Demographics
NPI:1508169558
Name:FIRST SMILES DENTAL, PC
Entity Type:Organization
Organization Name:FIRST SMILES DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:CHARVENE
Authorized Official - Last Name:FLETCHER-BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-714-6323
Mailing Address - Street 1:1671 SPRINGDALE DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2079
Mailing Address - Country:US
Mailing Address - Phone:803-432-3338
Mailing Address - Fax:803-432-3368
Practice Address - Street 1:1671 SPRINGDALE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2079
Practice Address - Country:US
Practice Address - Phone:803-432-3338
Practice Address - Fax:803-432-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3594261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental