# ISSAQUEENA PEDIATRIC DENTISTRY P.A.

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

## Provider details

- **NPI number:** 1992056378
- **Authorized official:** DR. CAMILLE W HORTON DMD (PRESIDENT)
- **Authorized official phone:** (864) 482-7900

## Contact information

- **Practice address:** 314 UNION STATION DR, SENECA, SC 29678-4547
- **Practice address phone:** (864) 482-7900
- **Practice address fax:** (864) 482-7510
- **Mailing address:** 314 UNION STATION DR, SENECA, SC 29678-4547
- **Mailing address phone:** (864) 482-7900
- **Mailing address fax:** (864) 482-7510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 4211 | SC | Yes |

## Other

- **Enumeration date:** 09/26/2012
- **Last updated:** 09/26/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1588875934 | — | SC |