| Dentrust Dental South Carolina Pc | |
|
4712 Liberty Division Ave Columbia SC 29207-5405 | |
| (803) 334-0530 | |
| Not Available |
| Full Name | Dentrust Dental South Carolina Pc |
|---|---|
| Speciality | Dentist |
| Location | 4712 Liberty Division Ave, Columbia, South Carolina |
| Authorized Official Name and Position | Amanda Clark (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 2679275000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dentrust Dental South Carolina Pc 1221 Vinewood Dr Seffner FL 33584-4829 Ph: (813) 451-4503 | Dentrust Dental South Carolina Pc 4712 Liberty Division Ave Columbia SC 29207-5405 Ph: (803) 334-0530 |
| NPI Number | 1588407340 |
|---|---|
| Provider Enumeration Date | 06/18/2024 |
| Last Update Date | 06/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588407340 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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