# EDISTO DENTAL ASSOCIATES OF SC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** J. Michael Havird, DMD, PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386891463
- **Authorized official:** MRS. JULIE CORLEY (OFFICE MANAGER)
- **Authorized official phone:** (803) 279-0015

## Contact information

- **Practice address:** 51 STATION CT STE C, EDISTO ISLAND, SC 29438-3020
- **Practice address phone:** (843) 869-3368
- **Mailing address:** PO BOX 218, EDISTO ISLAND, SC 29438-0218
- **Mailing address phone:** (843) 869-3368

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 2109 | SC | Yes |

## Other

- **Enumeration date:** 08/20/2008
- **Last updated:** 08/20/2008