| Ivy Creek Family Dentistry Llc | |
|
9007 Two Notch Rd Ste B Columbia SC 29223-5834 | |
| (803) 302-4445 | |
| Not Available |
| Full Name | Ivy Creek Family Dentistry Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9007 Two Notch Rd Ste B, Columbia, South Carolina |
| Authorized Official Name and Position | Chermaine Latrice Lyde (OWNER/PARTNER) |
| Authorized Official Contact | 8033024445 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Creek Family Dentistry Llc 337 Oakpointe Ln Lexington SC 29072-7232 Ph: (912) 695-8540 | Ivy Creek Family Dentistry Llc 9007 Two Notch Rd Ste B Columbia SC 29223-5834 Ph: (803) 302-4445 |
| NPI Number | 1962033001 |
|---|---|
| Provider Enumeration Date | 01/28/2020 |
| Last Update Date | 01/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962033001 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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