Provider Demographics
NPI:1841478146
Name:SANDHILLS COMMUNITY DENTISTRY
Entity type:Organization
Organization Name:SANDHILLS COMMUNITY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-680-0813
Mailing Address - Street 1:645 S SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:MC BEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101-7101
Mailing Address - Country:US
Mailing Address - Phone:843-680-0813
Mailing Address - Fax:843-335-6309
Practice Address - Street 1:645 S SEVENTH ST
Practice Address - Street 2:
Practice Address - City:MC BEE
Practice Address - State:SC
Practice Address - Zip Code:29101-7101
Practice Address - Country:US
Practice Address - Phone:843-680-0813
Practice Address - Fax:843-335-6309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDHILLS MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-08
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCZA9427261QF0400X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9427Medicaid