Organization
CAPITAL CHILDREN'S DENTAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN RAINES DMD (PARTNER)
(803) 951-9100
Entity
Organization
Contact information
Practice address
655 SAINT ANDREWS RD, SUITE 8, COLUMBIA, SC 29210-5112
(803) 252-7725
Mailing address
139 WHITEFORD WAY, LEXINGTON, SC 29072-7965
(803) 951-9100
(803) 951-1910
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9467
—
SC
Enumeration date
05/15/2007
Last updated
08/22/2020
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