Provider Demographics
NPI:1942601174
Name:CAROLINA DENTAL DOCS LLC GENERAL DENTISTRY FOR KIDS
Entity Type:Organization
Organization Name:CAROLINA DENTAL DOCS LLC GENERAL DENTISTRY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-641-0495
Mailing Address - Street 1:1460 JOHN B WHITE SR BLVD, STE 1-C
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306
Mailing Address - Country:US
Mailing Address - Phone:864-641-0495
Mailing Address - Fax:864-707-2133
Practice Address - Street 1:1460 JOHN B WHITE SR BLVD, STE 1-C
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306
Practice Address - Country:US
Practice Address - Phone:864-641-0495
Practice Address - Fax:864-707-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty