Organization
FORTH DENTAL CHARLESTON, LLC
Active
Other names
J. Bradford Smith and Assoc
Organization subpart
No
Provider details
NPI number
Authorized official
DEENA MARIE PHIMVONGSA OPERATIONAL MANAGER (OPERATIONS MANAGER)
(702) 354-4569
Entity
Organization
Contact information
Practice address
454 CLEMSON RD, COLUMBIA, SC 29229-7925
(034) 623-6628
(803) 619-6053
Mailing address
454 CLEMSON RD, COLUMBIA, SC 29229-7925
(034) 623-6628
(803) 619-6053
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Enumeration date
05/12/2025
Last updated
05/12/2025
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