Provider Demographics
NPI:1346589579
Name:TOTAL DENTAL CARE OF ORANGEBURG
Entity type:Organization
Organization Name:TOTAL DENTAL CARE OF ORANGEBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-576-7169
Mailing Address - Street 1:630 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4835
Mailing Address - Country:US
Mailing Address - Phone:803-534-5550
Mailing Address - Fax:803-534-3963
Practice Address - Street 1:630 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4835
Practice Address - Country:US
Practice Address - Phone:803-534-5550
Practice Address - Fax:803-534-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4457122300000X
SC1926122300000X
SC3811124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty