| Providence Dental Group Llc | |
|
220 Bridges Rd Simpsonville SC 29681-5700 | |
| (864) 675-6445 | |
| (864) 675-6447 |
| Full Name | Providence Dental Group Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 220 Bridges Rd, Simpsonville, South Carolina |
| Authorized Official Name and Position | Jason Phillip Makowski (MEMBER) |
| Authorized Official Contact | 8646756445 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Dental Group Llc 220 Bridges Rd Simpsonville SC 29681-5700 Ph: (864) 675-6445 | Providence Dental Group Llc 220 Bridges Rd Simpsonville SC 29681-5700 Ph: (864) 675-6445 |
| NPI Number | 1760502181 |
|---|---|
| Provider Enumeration Date | 03/30/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760502181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | SC 3724 (South Carolina) | Primary |
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