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Organization
WILD SMILES, LLC
Active
Organization
WILD SMILES, LLC
Active
Other names
Pediatric Dental of Lexington
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA M. BABCOCK (INSURANCE COORDINATOR)
(803) 356-1606
Entity
Organization
Contact information
Practice address
203 NORTH LAKE DRIVE, LEXINGTON, SC 29072
(803) 356-1606
(803) 359-7542
Mailing address
203 NORTH LAKE DRIVE, LEXINGTON, SC 29072
(803) 356-1606
(803) 359-7542
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
3351
SC
1223P0221X
Pediatric Dentistry
Primary
SC3351
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275696023
NPI
SC
01
—
1720106610
NPI
SC
05
—
Z33517
—
SC
05
—
ZX3864
—
SC
Enumeration date
09/12/2007
Last updated
12/16/2010
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