Provider Demographics
NPI:1598099178
Name:NORTHWOOD DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTHWOOD DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-359-3215
Mailing Address - Street 1:510 NORTHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2128
Mailing Address - Country:US
Mailing Address - Phone:803-359-3215
Mailing Address - Fax:803-359-8664
Practice Address - Street 1:510 NORTHWOOD RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2128
Practice Address - Country:US
Practice Address - Phone:803-359-3215
Practice Address - Fax:803-359-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC4468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty