Provider Demographics
NPI:1114287042
Name:GOLD HILL DENTISTRY, PLLC
Entity type:Organization
Organization Name:GOLD HILL DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGUNARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-547-4466
Mailing Address - Street 1:2848 PLEASANT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-9215
Mailing Address - Country:US
Mailing Address - Phone:803-547-4466
Mailing Address - Fax:803-547-4660
Practice Address - Street 1:2848 PLEASANT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-9215
Practice Address - Country:US
Practice Address - Phone:803-547-4466
Practice Address - Fax:803-547-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46921223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty