Provider Demographics
NPI:1396353850
Name:OZDENER, GOKHAN BARIS (DMD, DSC)
Entity type:Individual
Prefix:
First Name:GOKHAN
Middle Name:BARIS
Last Name:OZDENER
Suffix:
Gender:M
Credentials:DMD, DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 GARNERS FERRY RD STE X
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1632
Mailing Address - Country:US
Mailing Address - Phone:803-661-8412
Mailing Address - Fax:
Practice Address - Street 1:6420 GARNERS FERRY RD STE X
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1632
Practice Address - Country:US
Practice Address - Phone:803-661-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118711223G0001X
MADH89933124Q00000X
SC95591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11871OtherNC STATE OF DENTAL BOARD
SC9559OtherSC DENTAL BOARD