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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