| Edgar H Peacock, Jr, Dds, Pa | |
|
2750 Laurel St Suite 202 Columbia SC 29204-2038 | |
| (803) 256-9268 | |
| (803) 256-0084 |
| Full Name | Edgar H Peacock, Jr, Dds, Pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2750 Laurel St, Columbia, South Carolina |
| Authorized Official Name and Position | Edgar Harold Peacock (PRESIDENT) |
| Authorized Official Contact | 8032569268 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgar H Peacock, Jr, Dds, Pa 2750 Laurel St Suite 202 Columbia SC 29204-2038 Ph: (803) 256-9268 | Edgar H Peacock, Jr, Dds, Pa 2750 Laurel St Suite 202 Columbia SC 29204-2038 Ph: (803) 256-9268 |
| NPI Number | 1952587644 |
|---|---|
| Provider Enumeration Date | 01/14/2008 |
| Last Update Date | 01/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952587644 | NPI | - | NPPES |
| Z15458 | Medicaid | SC | |
| ZA9549 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 1545/OS161 (South Carolina) | Primary |
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