Provider Demographics
NPI:1730740887
Name:LOTUS DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:LOTUS DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NHUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-548-8858
Mailing Address - Street 1:1365 BROADCLOTH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-4507
Mailing Address - Country:US
Mailing Address - Phone:803-548-8858
Mailing Address - Fax:803-548-8860
Practice Address - Street 1:1365 BROADCLOTH ST STE 204
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-4507
Practice Address - Country:US
Practice Address - Phone:803-548-8858
Practice Address - Fax:803-548-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental