Provider Demographics
NPI:1982913752
Name:PARK PLACE DENTISTRY, LLC
Entity Type:Organization
Organization Name:PARK PLACE DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-482-2400
Mailing Address - Street 1:203B CENTRAL PARK LN
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-1156
Mailing Address - Country:US
Mailing Address - Phone:864-482-2400
Mailing Address - Fax:864-482-2404
Practice Address - Street 1:203B CENTRAL PARK LN
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1156
Practice Address - Country:US
Practice Address - Phone:864-482-2400
Practice Address - Fax:864-482-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4218122300000X
SC1109122300000X
SC493124Q00000X
SC8328124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty