Provider Demographics
NPI:1588792998
Name:DENTAL TEAM OF SUMTER, P.A.
Entity type:Organization
Organization Name:DENTAL TEAM OF SUMTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:CAPERS
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-494-8466
Mailing Address - Street 1:5635 BROAD ST EXT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154
Mailing Address - Country:US
Mailing Address - Phone:803-494-8466
Mailing Address - Fax:803-494-8472
Practice Address - Street 1:5635 BROAD ST EXT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154
Practice Address - Country:US
Practice Address - Phone:803-494-8466
Practice Address - Fax:803-494-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty