| Berkeley Oral And Maxillofacial Surgery Pa | |
|
111 Shelly St. Bonneau SC 29431-0280 | |
| (843) 825-4131 | |
| (843) 825-4136 |
| Full Name | Berkeley Oral And Maxillofacial Surgery Pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 111 Shelly St., Bonneau, South Carolina |
| Authorized Official Name and Position | James Albert Montgomery (ORAL SURGEON) |
| Authorized Official Contact | 8438254131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Berkeley Oral And Maxillofacial Surgery Pa Po Box 280 Bonneau SC 29431-0280 Ph: (843) 825-4131 | Berkeley Oral And Maxillofacial Surgery Pa 111 Shelly St. Bonneau SC 29431-0280 Ph: (843) 825-4131 |
| NPI Number | 1558486845 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558486845 | NPI | - | NPPES |
| 1790759967 | Other | SC | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 3180 (South Carolina) | Primary |