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ANCIENT MARINER LLC NPI 1225456247


NPI Information

NPI: 1225456247
Provider Name: ANCIENT MARINER, LLC

Doing Business As: CHILDREN AND ADULT DENTAL GROUP

Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
1118 GREENLAWN DR
COLUMBIA, SC
ZIP 29209
Phone: (803) 807-2140
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ANCIENT MARINER, LLC is a dental clinic center in Columbia, SC. ANCIENT MARINER, LLC NPI is 1225456247. The provider is registered as an organization entity type.
The provider Is Doing Business As Children And Adult Dental Group.

The provider's business location address is:

1118 GREENLAWN DR
COLUMBIA, SC
ZIP 29209-606
Phone: (803) 807-2140

The provider's authorized official is Tonia Patterson .
The authorized official title is Office Administrator and has the following contact phone number (803) 600-7211.

The enumeration date for this NPI number is 4/7/2014 and was last updated on 10/27/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QD0000XClinic/CenterDental2905SOUTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Z29050MEDICAIDSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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