MID-CAROLINA DENTAL CARE, INC
NPI: 1073050639
· PROSPERITY, SC 29127
· Dentist
· NPI assigned 01/20/2017
$194.40
Total Medicaid Paid
Provider Details
| Authorized Official | LAKE, JOHN (GENERAL DENTIST) |
| NPI Enumeration Date | 01/20/2017 |
Related Entities
Other providers sharing the same authorized official: LAKE, JOHN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
12 |
$194.40 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$194.40 |