Provider Demographics
NPI:1215346630
Name:TWO NOTCH ROAD DENTAL HEALTH CENTER
Entity type:Organization
Organization Name:TWO NOTCH ROAD DENTAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF HR & COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:REAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-603-4779
Mailing Address - Street 1:3014 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2822
Mailing Address - Country:US
Mailing Address - Phone:803-691-9930
Mailing Address - Fax:
Practice Address - Street 1:3014 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2822
Practice Address - Country:US
Practice Address - Phone:803-691-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty