Organization
KEVIN G. EUBANKS, D.M.D
Active
Other names
Southern Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLI GRAY (BUSINESS COORDINATOR)
(803) 641-3883
Entity
Organization
Contact information
Practice address
174 CREPE MYRTLE DRIVE, AIKEN, SC 29803
(803) 641-3883
Mailing address
174 CREPE MYRTLE DRIVE, AIKEN, SC 29803
(803) 641-3883
(803) 641-3198
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3587
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3587
SOUTH CAROLINA BOARD
SC
Enumeration date
09/06/2017
Last updated
09/06/2017
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