Provider Demographics
NPI:1528682085
Name:CAROLINA DENTISTRY LLC
Entity type:Organization
Organization Name:CAROLINA DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:NUNEZ
Authorized Official - Last Name:ANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-730-1757
Mailing Address - Street 1:2329 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2431
Mailing Address - Country:US
Mailing Address - Phone:803-799-3368
Mailing Address - Fax:
Practice Address - Street 1:2329 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2431
Practice Address - Country:US
Practice Address - Phone:803-799-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty