| Immediate Dental Group Columbia | |
|
1118 Greenlawn Drive Columbia SC 29209 | |
| (803) 807-2140 | |
| (803) 807-2141 |
| Full Name | Immediate Dental Group Columbia |
|---|---|
| Speciality | Dentist |
| Location | 1118 Greenlawn Drive, Columbia, South Carolina |
| Authorized Official Name and Position | Zachary Todd Daugherty (BUSINESS MANAGER) |
| Authorized Official Contact | 9105263487 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Immediate Dental Group Columbia 1118 Greenlawn Drive Columbia SC 29209 Ph: (803) 807-2140 | Immediate Dental Group Columbia 1118 Greenlawn Drive Columbia SC 29209 Ph: (803) 807-2140 |
| NPI Number | 1790039212 |
|---|---|
| Provider Enumeration Date | 11/06/2012 |
| Last Update Date | 11/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790039212 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | SC2662 (South Carolina) | Primary |
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