Organization
INDIGO DENTISTRY WEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L RAINS (OWNER)
(803) 348-7401
Entity
Organization
Contact information
Practice address
113 MEDICAL CIR, WEST COLUMBIA, SC 29169-3655
(803) 796-9312
Mailing address
121 ALPINE CIR, COLUMBIA, SC 29223-6385
(803) 348-7401
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/30/2021
Last updated
05/30/2021
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