CAROLINA DENTAL DOCS - ON - THE - GO, LLC
NPI: 1396121547
· SPARTANBURG, SC 29301
· General Practice Dentistry
· NPI assigned 08/10/2015
$417.60
Total Medicaid Paid
Provider Details
| Authorized Official | SNOW, JENNIFER (CREDENTIALING COORDINATOR) |
| NPI Enumeration Date | 08/10/2015 |
Related Entities
Other providers sharing the same authorized official: SNOW, JENNIFER
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
12 |
$417.60 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12 |
12 |
$417.60 |