Provider Demographics
NPI:1699051466
Name:R NICHOLAS COST JR DDS PA
Entity type:Organization
Organization Name:R NICHOLAS COST JR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:COST
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-984-7323
Mailing Address - Street 1:318 W FARLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-3055
Mailing Address - Country:US
Mailing Address - Phone:864-984-7323
Mailing Address - Fax:
Practice Address - Street 1:318 W FARLEY AVE
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-3055
Practice Address - Country:US
Practice Address - Phone:864-984-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD 70821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty