Provider Demographics
NPI:1982975603
Name:PALMETTO PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:PALMETTO PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAWHON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-865-1421
Mailing Address - Street 1:147 SUMMIT CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7613
Mailing Address - Country:US
Mailing Address - Phone:803-865-1421
Mailing Address - Fax:
Practice Address - Street 1:605 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4301
Practice Address - Country:US
Practice Address - Phone:803-865-1421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty