# EDGAR H PEACOCK, JR, DDS, PA

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

## Provider details

- **NPI number:** 1952587644
- **Authorized official:** DR. EDGAR HAROLD PEACOCK JR. D. D. S (PRESIDENT)
- **Authorized official phone:** (803) 256-9268

## Contact information

- **Practice address:** 2750 LAUREL ST, SUITE 202, COLUMBIA, SC 29204-2038
- **Practice address phone:** (803) 256-9268
- **Practice address fax:** (803) 256-0084
- **Mailing address:** 2750 LAUREL ST, SUITE 202, COLUMBIA, SC 29204-2038
- **Mailing address phone:** (803) 256-9268
- **Mailing address fax:** (803) 256-0084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 1545/OS161 | SC | Yes |

## Other

- **Enumeration date:** 01/14/2008
- **Last updated:** 01/14/2008