| Solomon Kids Pediatric Dentistry Knightsville Llc | |
|
491 W Butternut Rd Summerville SC 29483-5507 | |
| (843) 871-0842 | |
| Not Available |
| Full Name | Solomon Kids Pediatric Dentistry Knightsville Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 491 W Butternut Rd, Summerville, South Carolina |
| Authorized Official Name and Position | Angela Marie Bazzle (OPERATION MANAGER) |
| Authorized Official Contact | 8438710842 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Solomon Kids Pediatric Dentistry Knightsville Llc 1971 N Main St Summerville SC 29486-7820 Ph: (843) 871-0842 | Solomon Kids Pediatric Dentistry Knightsville Llc 491 W Butternut Rd Summerville SC 29483-5507 Ph: (843) 871-0842 |
| NPI Number | 1770006876 |
|---|---|
| Provider Enumeration Date | 07/20/2017 |
| Last Update Date | 07/20/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770006876 | NPI | - | NPPES |
| ZX8526 | Medicaid | SC | |
| ZX8227 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 8526 (South Carolina) | Primary |
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