Provider Demographics
NPI:1063285864
Name:HIGHFIVE ENDODONTICS SOUTH CAROLINA, LLC
Entity type:Organization
Organization Name:HIGHFIVE ENDODONTICS SOUTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:NIMMICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-905-4433
Mailing Address - Street 1:2570 LIN DO CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1832
Mailing Address - Country:US
Mailing Address - Phone:803-905-4433
Mailing Address - Fax:803-905-4434
Practice Address - Street 1:2570 LIN DO CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1832
Practice Address - Country:US
Practice Address - Phone:803-905-4433
Practice Address - Fax:803-905-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty