Individual
CHANDA TRISHAUNE ELZIE MEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
719 OKATIE HWY # 170, OKATIE, SC 29909-3963
(843) 987-7400
Mailing address
PO BOX 357, RIDGELAND, SC 29936-2605
(843) 987-7400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
011979
GA
1223G0001X
General Practice Dentistry
Primary
4669
SC
Other
Enumeration date
07/18/2006
Last updated
03/11/2020
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