Provider Demographics
NPI:1851610141
Name:PALMETTO DENTISTRY
Entity Type:Organization
Organization Name:PALMETTO DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:STROUD
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-774-8788
Mailing Address - Street 1:110 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-3417
Mailing Address - Country:US
Mailing Address - Phone:843-774-8788
Mailing Address - Fax:843-774-1755
Practice Address - Street 1:110 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3417
Practice Address - Country:US
Practice Address - Phone:843-774-8788
Practice Address - Fax:843-774-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty