| Upstate Oral And Maxillofacial Surgery, P.a. | |
|
280 North Grove Medical Park Dr. Spartanburg SC 29303-4222 | |
| (864) 585-3318 | |
| (864) 585-4800 |
| Full Name | Upstate Oral And Maxillofacial Surgery, P.a. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 280 North Grove Medical Park Dr., Spartanburg, South Carolina |
| Authorized Official Name and Position | Wiiliam P. Mills (OWNER) |
| Authorized Official Contact | 8645853318 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Upstate Oral And Maxillofacial Surgery, P.a. 280 North Grove Medical Park Drive Spartanburg SC 29303-4222 Ph: (864) 585-3318 | Upstate Oral And Maxillofacial Surgery, P.a. 280 North Grove Medical Park Dr. Spartanburg SC 29303-4222 Ph: (864) 585-3318 |
| NPI Number | 1366577389 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 01/06/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366577389 | NPI | - | NPPES |
| ZA9899 | Medicaid | SC | |
| Z21218 | Medicaid | SC | |
| Z21432 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2121 (South Carolina) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2143 (South Carolina) | Secondary |
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