# POWDERSVILLE PEDIATRIC DENTISTRY, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417965922
- **Authorized official:** DR. MELANIE RICHARDS DMD (OWNER PRESIDENT)
- **Authorized official phone:** (864) 220-5437

## Contact information

- **Practice address:** 10705 ANDERSON ROAD, EASLEY, SC 29642
- **Practice address phone:** (864) 220-5437
- **Practice address fax:** (864) 220-0420
- **Mailing address:** 10705 ANDERSON ROAD, EASLEY, SC 29642
- **Mailing address phone:** (864) 220-5437
- **Mailing address fax:** (864) 220-0420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 3152 | SC | Yes |

## Other

- **Enumeration date:** 08/03/2006
- **Last updated:** 09/09/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 214665 | ANTHEM BLUE CROSS | — |
| 01 | — | 3126152 | BLUE CROSS BLUE SHIELD | TN |
| 01 | — | 706109 | UNITED CONCORDIA | — |
| 01 | — | 88009615 | BLUE CROSS BLUE SHIELD | AL |
| 05 | — | ZA9574 | — | SC |