Provider Demographics
NPI:1710623525
Name:PALMETTO FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:PALMETTO FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-877-6703
Mailing Address - Street 1:2590 TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1860
Mailing Address - Country:US
Mailing Address - Phone:803-877-6703
Mailing Address - Fax:803-469-3515
Practice Address - Street 1:656 BULTMAN DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2550
Practice Address - Country:US
Practice Address - Phone:803-778-2337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO FAMILY & COSMETIC DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental