Provider Demographics
NPI:1538320361
Name:MIDLANDS ENDODONTICS
Entity Type:Organization
Organization Name:MIDLANDS ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRAMELL
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:803-808-1110
Mailing Address - Street 1:108 PALMETTO PARK BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7968
Mailing Address - Country:US
Mailing Address - Phone:803-808-1110
Mailing Address - Fax:803-808-1188
Practice Address - Street 1:108 PALMETTO PARK BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7968
Practice Address - Country:US
Practice Address - Phone:803-808-1110
Practice Address - Fax:803-808-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty