| Ph Dentistry | |
|
10 Richland Medical Park Dr Ste A Columbia SC 29203-6892 | |
| (803) 434-6565 | |
| Not Available |
| Full Name | Ph Dentistry |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 10 Richland Medical Park Dr Ste A, Columbia, South Carolina |
| Authorized Official Name and Position | Kristi Lawrence (DIRECTOR, PROVIDER ENROLLMENT) |
| Authorized Official Contact | 8645228611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ph Dentistry Po Box 743904 Atlanta GA 30374-3904 Ph: (803) 296-7320 | Ph Dentistry 10 Richland Medical Park Dr Ste A Columbia SC 29203-6892 Ph: (803) 434-6565 |
| NPI Number | 1417442864 |
|---|---|
| Provider Enumeration Date | 06/28/2018 |
| Last Update Date | 02/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417442864 | NPI | - | NPPES |
| ZA8984 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (South Carolina) | Primary |
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