Provider Demographics
NPI:1295741056
Name:RICHALND NORTHEAST DENTAL ASSOCIATES,LLC
Entity type:Organization
Organization Name:RICHALND NORTHEAST DENTAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-865-0645
Mailing Address - Street 1:700 RABON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8900
Mailing Address - Country:US
Mailing Address - Phone:803-865-0645
Mailing Address - Fax:803-865-5015
Practice Address - Street 1:700 RABON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8900
Practice Address - Country:US
Practice Address - Phone:803-865-0645
Practice Address - Fax:803-865-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty