Provider Demographics
NPI:1811361579
Name:WHITE KNOLL COMPREHENSIVE DENTISTRY
Entity Type:Organization
Organization Name:WHITE KNOLL COMPREHENSIVE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-785-9991
Mailing Address - Street 1:1825 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7759
Mailing Address - Country:US
Mailing Address - Phone:803-785-9991
Mailing Address - Fax:803-785-6921
Practice Address - Street 1:1825 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7759
Practice Address - Country:US
Practice Address - Phone:803-785-9991
Practice Address - Fax:803-785-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty