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Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Pelion Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DELGADO CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
8063 EDMUND HWY, PELION, SC 29123-9805
(803) 894-3736
(803) 894-5315
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 753-5591
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9096
—
SC
Enumeration date
07/19/2016
Last updated
02/10/2022
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