| Mountain Lakes Family Dentstry | |
|
635 Old Greenville Hwy Clemson SC 29631-1219 | |
| (864) 722-9255 | |
| Not Available |
| Full Name | Mountain Lakes Family Dentstry |
|---|---|
| Speciality | Dentist |
| Location | 635 Old Greenville Hwy, Clemson, South Carolina |
| Authorized Official Name and Position | Ryan Patrick Macrae (DENTIST-OWNER) |
| Authorized Official Contact | 8647229255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Lakes Family Dentstry 635 Old Greenville Hwy Clemson SC 29631-1219 Ph: (864) 722-9255 | Mountain Lakes Family Dentstry 635 Old Greenville Hwy Clemson SC 29631-1219 Ph: (864) 722-9255 |
| NPI Number | 1124304795 |
|---|---|
| Provider Enumeration Date | 10/27/2011 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124304795 | NPI | - | NPPES |
| 2X4031 | Medicaid | SC | |
| 4031 | Other | SC | LICENSE# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4031 (South Carolina) | Primary |
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