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630 Laurel St Orangeburg SC 29115-4835 | |
| (803) 534-5550 | |
| (803) 534-3963 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 630 Laurel St, Orangeburg, South Carolina |
| Authorized Official Name and Position | Kirkland Woodruff Clark (OWNER/DENTIST) |
| Authorized Official Contact | 8035345550 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 517 Orangeburg SC 29116-0517 Ph: (803) 534-5550 | 630 Laurel St Orangeburg SC 29115-4835 Ph: (803) 534-5550 |
| NPI Number | 1548571078 |
|---|---|
| Provider Enumeration Date | 06/30/2010 |
| Last Update Date | 06/30/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548571078 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4457 (South Carolina) | Primary |
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