Provider Demographics
NPI:1124635495
Name:DESTINATION DENTAL OF DUNCAN LLC
Entity type:Organization
Organization Name:DESTINATION DENTAL OF DUNCAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-550-4590
Mailing Address - Street 1:401 COMMERCE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2724
Mailing Address - Country:US
Mailing Address - Phone:215-550-4590
Mailing Address - Fax:215-646-6166
Practice Address - Street 1:155 DEACON TILLER CT
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-8880
Practice Address - Country:US
Practice Address - Phone:864-485-2214
Practice Address - Fax:864-485-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty