Provider Demographics
NPI:1972084499
Name:DENTISTS OF WEST COLUMBIA, PC
Entity type:Organization
Organization Name:DENTISTS OF WEST COLUMBIA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-486-2612
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8280
Mailing Address - Fax:303-952-0892
Practice Address - Street 1:2265 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4523
Practice Address - Country:US
Practice Address - Phone:803-486-2612
Practice Address - Fax:803-486-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty