Provider Demographics
NPI:1740351097
Name:PALMETTO COMPREHENSIVE DENTISTRY LLC
Entity type:Organization
Organization Name:PALMETTO COMPREHENSIVE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-359-0566
Mailing Address - Street 1:209 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2633
Mailing Address - Country:US
Mailing Address - Phone:803-359-0566
Mailing Address - Fax:803-359-5170
Practice Address - Street 1:209 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2633
Practice Address - Country:US
Practice Address - Phone:803-359-0566
Practice Address - Fax:803-359-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9471Medicaid
SCZX3788Medicaid