FOUNTAIN INN DENTAL, LLC (NPI# 1235653031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235653031 |
| Entity Type | Organization |
| Organization Name | FOUNTAIN INN DENTAL, LLC |
| Other Organization Name | FOUNTAIN INN DENTAL |
| Practice Address |
1125 N Main St Fountain Inn SC 29644-1322 |
| Practice Telephone | (864) 409-7733 |
| Mailing Telephone | 8644097733 |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2017-08-02 |
| Authorized Official Name | VIKAS R. JAIN (OWNER) |
| Authorized Official Telephone | 7068774110 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Fountain Inn Dental | Doing Business As Name - Organization |
| Street Address |
1125 N MAIN ST |
| City | FOUNTAIN INN |
| State | SC |
| Zip Code | 29644-1322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669838991 | Palms Dentistry 225, LLC | Dentist | 208 Harrison Bridge Road, Fountain Inn, SC 29644 | 2015-12-31 |
| 1902155641 | Leah M Mauritz | Pharmacist | 203 N. Main St., Fountain Inn, SC 29644 | 2012-09-07 |
| 1164791778 | Lyfe Intervention Services | Community/Behavioral Health | 401 Putman Street, Fountain Inn, SC 29644 | 2011-12-28 |
| 1629119318 | South Carolina Department of Juvenile Justice | Residential Treatment Facility, Emotionally Disturbed Children | 810 Dunklin Bridge Road, Fountain Inn, SC 29644 | 2007-02-08 |
| 1093218992 | Emili Walker Hendrix | Occupational Therapist | 204 Shady Pines Ct, Fountain Inn, SC 29644 | 2018-03-16 |
| 1841331717 | South Carolina Department of Juvenile Justice | Residential Treatment Facility, Emotionally Disturbed Children | 810 Dunklin Bridge Road, Fountain Inn, SC 29644 | 2007-02-12 |
| 1912300971 | Grouphab | Clinic/Center | 30 Howard Creek Dr, Fountain Inn, SC 29644-1318 | 2014-10-06 |
| 1457950875 | 360 Durable Medical Supplies & Equipment | Durable Medical Equipment & Medical Supplies | 1314 N Main St Ste D, Fountain Inn, SC 29644-1332 | 2020-10-19 |
| 1790210839 | Mukta LLC | Pharmacy | 1103 N Main St Ste E, Fountain Inn, SC 29644-1336 | 2017-04-26 |
| 1457854564 | Tamera Burton Wilson | Specialist | 123 Village Vista Dr, Fountain Inn, SC 29644-1347 | 2018-03-15 |
| Find all providers in zip 29644 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669838991 | Palms Dentistry 225, LLC | Dentist | 208 Harrison Bridge Road, Fountain Inn, SC 29644 | 2015-12-31 |
| 1093819104 | Raymond Earl White Jr. | Dentist | 203 S Weston St, Fountain Inn, SC 29644-1964 | 2006-09-11 |
| 1255384038 | Ronald Brent Calcutt Jr. | Dentist | 703 N Main St, Fountain Inn, SC 29644-1611 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518564046 | Leishman Dental | Dentist | 121 N Pine St, Batesburg Leesville, SC 29006-1974 | 2020-10-07 |
| 1265039754 | Ravi Bhupen Patel | Dentist | 1755 Central Park Rd, Unit 1107, Charleston, SC 29412-2846 | 2020-10-07 |
| 1447857289 | Rick & Pamela Dhillon Dmd - Sda LLC | Dentist | 3115a Brushy Creek Rd, Greer, SC 29650-0903 | 2020-10-05 |
| 1598372864 | Dental Professional of South Carolina, P.C. | Dentist | 1417 Folly Rd Ste 402, Charleston, SC 29412-9737 | 2020-09-30 |
| 1043827314 | Dental Professionals of South Carolina, P.C. | Dentist | 1767 Heckle Blvd Ste 102, Rock Hill, SC 29732-1878 | 2020-09-30 |
| 1497361307 | Cane Bay Family Dentistry - Goose Creek LLC | Dentist | 129 Plantation North Blvd, Unit D, Goosecreek, SC 29445-2944 | 2020-09-17 |
| 1851906028 | Carolina Park Family Dentistry LLC | Dentist | 3520 Park Avenue Blvd., Suite 100, Mount Pleasant, SC 29466-2946 | 2020-09-14 |
| 1952915027 | Vdp Okatie LLC | Dentist | 10 William Pope Drive, Suite #2, Okatie, SC 29909 | 2020-09-04 |
| 1881208296 | Amanda Ho Van Garrett | Dentist | 122 S Goose Creek Blvd Ste A, Goose Creek, SC 29445-3136 | 2020-09-02 |
| 1871107409 | Ashley Czechner | Dentist | 11990 Highway 17 Byp Ste 8, Murrells Inlet, SC 29576-9379 | 2020-09-01 |
| Find all providers with the same taxonomy | ||||
| City | FOUNTAIN INN |
| Zip Code | 29644 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.