Provider Demographics
NPI:1417773037
Name:BREATHE COLUMBIA LLC
Entity type:Organization
Organization Name:BREATHE COLUMBIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-782-5492
Mailing Address - Street 1:3731 FOREST DR STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4007
Mailing Address - Country:US
Mailing Address - Phone:803-782-5492
Mailing Address - Fax:
Practice Address - Street 1:3731 FOREST DR STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4007
Practice Address - Country:US
Practice Address - Phone:803-782-5492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty