Provider Demographics
NPI:1508924705
Name:CAROLINA ENDODONTICS
Entity Type:Organization
Organization Name:CAROLINA ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GOHEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-798-8476
Mailing Address - Street 1:130 STONEMARK LANE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3841
Mailing Address - Country:US
Mailing Address - Phone:803-798-8476
Mailing Address - Fax:803-798-6451
Practice Address - Street 1:130 STONEMARK LANE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3841
Practice Address - Country:US
Practice Address - Phone:803-798-8476
Practice Address - Fax:803-798-6451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty