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Organization
SOUTHLAKE FAMILY DENTISTRY LLC
Active
Organization
SOUTHLAKE FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY C KIMSEY D.M.D.,F.A.G.D. (PRESIDENT)
(803) 548-3342
Entity
Organization
Contact information
Practice address
1741 GOLD HILL RD, SUITE 2010, FORT MILL, SC 29708-8202
(803) 548-3342
(803) 548-3817
Mailing address
1741 GOLD HILL RD, SUITE 2010, FORT MILL, SC 29708-8202
(803) 548-3342
(803) 548-3817
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2588
SC
1223G0001X
General Practice Dentistry
3549
SC
Other
Enumeration date
07/14/2006
Last updated
07/16/2007
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