Provider Demographics
NPI:1396899175
Name:CAROLINA CHILDREN'S DENTISTRY, PA
Entity type:Organization
Organization Name:CAROLINA CHILDREN'S DENTISTRY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-736-6000
Mailing Address - Street 1:7701 TRENHOLM ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1725
Mailing Address - Country:US
Mailing Address - Phone:803-736-6000
Mailing Address - Fax:
Practice Address - Street 1:7701 TRENHOLM ROAD EXT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1725
Practice Address - Country:US
Practice Address - Phone:803-736-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9715Medicaid