| Special Care Dental Of South Carolina, Llc | |
|
12910 Shelbyville Rd Ste 300 Louisville KY 40243-2404 | |
| (502) 244-2441 | |
| (502) 254-4086 |
| Full Name | Special Care Dental Of South Carolina, Llc |
|---|---|
| Speciality | Dentist |
| Location | 12910 Shelbyville Rd Ste 300, Louisville, Kentucky |
| Authorized Official Name and Position | Kent Ellington (OWNER) |
| Authorized Official Contact | 8552599183 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Special Care Dental Of South Carolina, Llc 317 Ruth Vista Rd Lexington SC 29073-8628 Ph: (855) 259-9183 | Special Care Dental Of South Carolina, Llc 12910 Shelbyville Rd Ste 300 Louisville KY 40243-2404 Ph: (502) 244-2441 |
| NPI Number | 1598156937 |
|---|---|
| Provider Enumeration Date | 02/06/2015 |
| Last Update Date | 02/06/2015 |
| Medicare PECOS PAC ID | 7113208018 |
|---|---|
| Medicare Enrollment ID | O20170109002028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598156937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Kent C Ellington |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1740260090 PECOS PAC ID: 7719269380 Enrollment ID: I20170117001895 |
| Provider Name | Deanthia Childs-wiggins |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1508087958 PECOS PAC ID: 7113296039 Enrollment ID: I20170710001663 |
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