| University Dental Llc | |
|
2329 Devine Street Columbia SC 29250 | |
| (803) 252-8101 | |
| (803) 779-7721 |
| Full Name | University Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 2329 Devine Street, Columbia, South Carolina |
| Authorized Official Name and Position | Loretta Kay Felder Mckelvey (OWNER PRESIDENT CEO) |
| Authorized Official Contact | 8032528101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| University Dental Llc Po Box 50664 2329 Devine Street Columbia SC 29250 Ph: (803) 252-8101 | University Dental Llc 2329 Devine Street Columbia SC 29250 Ph: (803) 252-8101 |
| NPI Number | 1568673069 |
|---|---|
| Provider Enumeration Date | 05/25/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568673069 | NPI | - | NPPES |
| ZZ2642 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | SC2642 (South Carolina) | Primary |
| 122300000X | Dentist | DN013211 (Georgia) | Secondary |
| 122300000X | Dentist | 0401411265 (Virginia) | Secondary |
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