| Midlands Oral And Maxillofacial Surgery | |
|
1755 Saint Julian Pl Columbia SC 29204-2409 | |
| (803) 254-2972 | |
| (803) 799-2151 |
| Full Name | Midlands Oral And Maxillofacial Surgery |
|---|---|
| Speciality | Dentist |
| Location | 1755 Saint Julian Pl, Columbia, South Carolina |
| Authorized Official Name and Position | Diane M Montes (INSURANCE COORDINATOR) |
| Authorized Official Contact | 8032542972 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midlands Oral And Maxillofacial Surgery 1755 Saint Julian Pl Columbia SC 29204-2409 Ph: (803) 254-2972 | Midlands Oral And Maxillofacial Surgery 1755 Saint Julian Pl Columbia SC 29204-2409 Ph: (803) 254-2972 |
| NPI Number | 1386699288 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7315970365 |
|---|---|
| Medicare Enrollment ID | O20050912000503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386699288 | NPI | - | NPPES |
| ZA9935 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 1788 (South Carolina) | Primary |
| Provider Name | Philip M Prickett |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1588629638 PECOS PAC ID: 4284694472 Enrollment ID: I20041012001383 |
| Provider Name | David B Tevepaugh |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1871570804 PECOS PAC ID: 2062417942 Enrollment ID: I20060927000535 |
| Provider Name | Joseph W Park |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1205813227 PECOS PAC ID: 5294730180 Enrollment ID: I20060927000579 |
| Provider Name | Heath M Stewart |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1164409058 PECOS PAC ID: 0749285633 Enrollment ID: I20060927000582 |
| Provider Name | James Lemon |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1518944404 PECOS PAC ID: 1658376496 Enrollment ID: I20060928000566 |
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