Provider Demographics
NPI:1689088676
Name:PAGELAND DENTISTRY PA
Entity Type:Organization
Organization Name:PAGELAND DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:VORONINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-672-2403
Mailing Address - Street 1:124 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728-2254
Mailing Address - Country:US
Mailing Address - Phone:843-672-2403
Mailing Address - Fax:843-672-3299
Practice Address - Street 1:124 S PEARL ST
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728-2254
Practice Address - Country:US
Practice Address - Phone:843-672-2403
Practice Address - Fax:843-672-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44351223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4435Medicaid