| Medicaid Dental Practice Of Easley, Sc, Inc | |
|
807 S Pendleton St Easley SC 29640-3527 | |
| (864) 855-6530 | |
| Not Available |
| Full Name | Medicaid Dental Practice Of Easley, Sc, Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 807 S Pendleton St, Easley, South Carolina |
| Authorized Official Name and Position | Shawn C Edwards (PRESIDENT) |
| Authorized Official Contact | 8648590111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medicaid Dental Practice Of Easley, Sc, Inc 415 S Pendleton St Easley SC 29640-3072 Ph: (864) 859-0111 | Medicaid Dental Practice Of Easley, Sc, Inc 807 S Pendleton St Easley SC 29640-3527 Ph: (864) 855-6530 |
| NPI Number | 1932399862 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 07/26/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932399862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3944 (South Carolina) | Primary |
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