1407576465 NPI number — RIVER LANDING DENTISTRY WEST SUMMERVILLE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407576465 NPI number — RIVER LANDING DENTISTRY WEST SUMMERVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER LANDING DENTISTRY WEST SUMMERVILLE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407576465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 RIVER LANDING DR UNIT 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANIEL ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29492-8612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-242-0645
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2636 HIGHWAY 17A S STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29483-9114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-242-0645
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2022

Additional Information

Authorized Official

Authorized Official Last Name:
ZECHMANN
Authorized Official First Name:
REBECA
Authorized Official Middle Name:
Authorized Official Title or Position:
ITS MEMBER
Authorized Official Telephone Number:
843-242-0645

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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