Provider Demographics
NPI:1851095053
Name:RESTORATIVE ARTS DENTAL PA
Entity Type:Organization
Organization Name:RESTORATIVE ARTS DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GROVER
Authorized Official - Middle Name:
Authorized Official - Last Name:RABON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-905-3567
Mailing Address - Street 1:669B W WESMARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1900
Mailing Address - Country:US
Mailing Address - Phone:803-905-3567
Mailing Address - Fax:
Practice Address - Street 1:669B W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1900
Practice Address - Country:US
Practice Address - Phone:803-905-3567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies