| Wild Smiles, Llc | |
|
203 North Lake Drive Lexington SC 29072 | |
| (803) 356-1606 | |
| (803) 359-7542 |
| Full Name | Wild Smiles, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 203 North Lake Drive, Lexington, South Carolina |
| Authorized Official Name and Position | Donna M. Babcock (INSURANCE COORDINATOR) |
| Authorized Official Contact | 8033561606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Smiles, Llc 203 North Lake Drive Lexington SC 29072 Ph: (803) 356-1606 | Wild Smiles, Llc 203 North Lake Drive Lexington SC 29072 Ph: (803) 356-1606 |
| NPI Number | 1295920346 |
|---|---|
| Provider Enumeration Date | 09/12/2007 |
| Last Update Date | 12/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295920346 | NPI | - | NPPES |
| 1720106610 | Other | SC | NPI |
| 1275696023 | Other | SC | NPI |
| ZX3864 | Medicaid | SC | |
| Z33517 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 3351 (South Carolina) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | SC3351 (South Carolina) | Primary |
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