Provider Demographics
NPI:1063941128
Name:COMPREHENSIVE DENTAL CENTER OF SOUTH CAROLINA
Entity type:Organization
Organization Name:COMPREHENSIVE DENTAL CENTER OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:DELINA
Authorized Official - Last Name:SINGLETARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-443-9097
Mailing Address - Street 1:841 ENTERPRISE RD STE A
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-7821
Mailing Address - Country:US
Mailing Address - Phone:843-487-5156
Mailing Address - Fax:843-487-5161
Practice Address - Street 1:841 ENTERPRISE RD STE A
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-7821
Practice Address - Country:US
Practice Address - Phone:843-487-5156
Practice Address - Fax:843-487-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC432076791OtherPRIVATE INSURANCES
SC432076791Medicaid