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Organization
803 DENTAL LLC
Active
Organization
803 DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YENAN XU (D.D.S.)
(347) 963-3531
Entity
Organization
Contact information
Practice address
1344 HIGHWAY 160 E, #101, FORT MILL, SC 29715
(803) 650-6352
Mailing address
4267 TOURNETTE DR, INDIAN LAND, SC 29707-9228
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/20/2024
Last updated
03/20/2024
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