Organization
CAROLINA DENTAL DOCS ON-THE-GO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM NASIM DMD (PRESIDENT)
(864) 641-0495
Entity
Organization
Contact information
Practice address
112 TOWNPARK DR NW, SUITE 100, KENNESAW, GA 30144-3731
(404) 410-1340
Mailing address
111 POWELL MILL RD, SPARTANBURG, SC 29301-1590
(864) 641-0495
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2881
SC
Other
Enumeration date
08/14/2015
Last updated
08/14/2015
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