Provider Demographics
NPI:1619367521
Name:RENEW OUR COMMUNITY, INC,
Entity Type:Organization
Organization Name:RENEW OUR COMMUNITY, INC,
Other - Org Name:ROC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-327-1910
Mailing Address - Street 1:125 HAMPTON ST STE 200
Mailing Address - Street 2:P.O. BOX 907
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3594
Mailing Address - Country:US
Mailing Address - Phone:803-327-1910
Mailing Address - Fax:803-327-2216
Practice Address - Street 1:125 HAMPTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4590
Practice Address - Country:US
Practice Address - Phone:803-327-1910
Practice Address - Fax:803-327-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCC36464299251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable