Provider Demographics
NPI:1053145607
Name:ANGEL OAK DENTAL LLC
Entity type:Organization
Organization Name:ANGEL OAK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-393-8401
Mailing Address - Street 1:103 PLANTERS DR
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-4040
Mailing Address - Country:US
Mailing Address - Phone:843-393-8401
Mailing Address - Fax:
Practice Address - Street 1:103 PLANTERS DR
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-4040
Practice Address - Country:US
Practice Address - Phone:843-393-8401
Practice Address - Fax:843-395-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty