Organization
MIDLANDS PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LAFORREST SHOUN DMD (DENTIST/OWNER)
(803) 348-8976
Entity
Organization
Contact information
Practice address
253 CEDARCREST DR, LEXINGTON, SC 29072-3812
(803) 951-7337
Mailing address
221 SPRINGS CT, WEST COLUMBIA, SC 29170-2474
(803) 951-7337
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3801
SC
Other
Enumeration date
08/24/2015
Last updated
08/24/2015
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