Provider Demographics
NPI:1841687241
Name:PALMETTO FAMILY AND COSMETIC DENTISTRY LLC
Entity type:Organization
Organization Name:PALMETTO FAMILY AND COSMETIC DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:H
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-773-5411
Mailing Address - Street 1:2590 TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1860
Mailing Address - Country:US
Mailing Address - Phone:803-773-5411
Mailing Address - Fax:803-773-8231
Practice Address - Street 1:434 N GUIGNARD DRIVE
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4748
Practice Address - Country:US
Practice Address - Phone:803-773-5411
Practice Address - Fax:803-773-8231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO FAMILY AND COSMETIC DENTISTRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-23
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4327261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental