Sweet Tooth Smiles P A
Dentist in West Columbia, SC. Organization (NPI-2).
NPI number1982105904
StatusActive
Last updated in NPPESJul 22, 2021
Details
- NPI
- 1982105904
- Entity type
- Organization (NPI-2)
- Legal business name
- Sweet Tooth Smiles P A
- Organization subpart
- No
- Enumeration date
- Feb 25, 2018
- Certification date
- Jul 22, 2021
- Last updated
- Jul 22, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 4571 | SC | Yes |
| 332BC3200X | Durable Medical Equipment & Medical Supplies, Customized Equipment | – | – |
Other names
- Dental Sleep Doc (Doing Business As)
Practice location
3020 Sunset Blvd Ste 106West Columbia, SC 29169-3494
Phone 803-233-1980 · Fax 803-602-6397
Mailing address
112 Mallard Lakes CtLexington, SC 29072-9300
Phone 920-254-9865
Authorized official
Erica Marguerite Johannes
President
9202549865
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