Individual
DR. GEORGEA B THEKKETHOTTIYIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
109 WINDSORGATE WAY, SIMPSONVILLE, SC 29681-3698
(267) 241-8248
Mailing address
109 WINDSORGATE WAY, SIMPSONVILLE, SC 29681-3698
(267) 241-8248
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.029190
IL
1223G0001X
General Practice Dentistry
Primary
8598
SC
Other
Enumeration date
09/13/2012
Last updated
10/17/2022
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