| Carolina Aesthetic Dentistry Pa | |
|
383 South Pine Street Suite 3 Spartanburg SC 29302 | |
| (864) 577-9400 | |
| (864) 577-9773 |
| Full Name | Carolina Aesthetic Dentistry Pa |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 383 South Pine Street, Spartanburg, South Carolina |
| Authorized Official Name and Position | Katherine Melissa Nicholson (DENTIST) |
| Authorized Official Contact | 8645779400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolina Aesthetic Dentistry Pa 383 South Pine Street Suite 3 Spartanburg SC 29302 Ph: (864) 577-9400 | Carolina Aesthetic Dentistry Pa 383 South Pine Street Suite 3 Spartanburg SC 29302 Ph: (864) 577-9400 |
| NPI Number | 1922115658 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922115658 | NPI | - | NPPES |
| ZA9539 | Medicaid | SC | |
| 233900 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | SC3390 (South Carolina) | Primary |
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