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General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1679539639

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
5576 CAROLINA HWY  DENMARK, SC 29042-2238 US
Tel: 803-793-3365  Fax: 803-793-3365

Contact information for business:
PO BOX 346  DENMARK, SC 29042-0346 US
Tel: 803-793-3365  Fax: 803-793-3365

Registration Information:
NPI: 1679539639
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Legacy codes, insurance codes and state license numbers:



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