Provider Demographics
NPI:1811659089
Name:COLUMBIA SC EMERGENCY DENTAL CARE USA LLC
Entity type:Organization
Organization Name:COLUMBIA SC EMERGENCY DENTAL CARE USA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-658-4687
Mailing Address - Street 1:4267 S 144TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1053
Mailing Address - Country:US
Mailing Address - Phone:402-393-2726
Mailing Address - Fax:
Practice Address - Street 1:105 N 12TH ST
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6412
Practice Address - Country:US
Practice Address - Phone:803-764-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty