| Columbia Periodontal Assoicates, Llc | |
|
3527 Bush River Rd Columbia SC 29210-4805 | |
| (803) 798-0894 | |
| (803) 731-7887 |
| Full Name | Columbia Periodontal Assoicates, Llc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 3527 Bush River Rd, Columbia, South Carolina |
| Authorized Official Name and Position | Laurel-jean M Mathis (OFFICE MANAGER) |
| Authorized Official Contact | 8037980894 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia Periodontal Assoicates, Llc 3527 Bush River Rd Columbia SC 29210-4805 Ph: (803) 798-0894 | Columbia Periodontal Assoicates, Llc 3527 Bush River Rd Columbia SC 29210-4805 Ph: (803) 798-0894 |
| NPI Number | 1548282130 |
|---|---|
| Provider Enumeration Date | 07/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548282130 | NPI | - | NPPES |
| ZA9736 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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