Organization
SUMMERHILL FAMILY & COSMETIC DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HIEU NGOC PHAN DMD (DENTIST)
(803) 397-9115
Entity
Organization
Contact information
Practice address
1604 SUMMERHILL RD, NORTH AUGUSTA, SC 29841-3067
(803) 279-6743
Mailing address
1604 SUMMERHILL RD, NORTH AUGUSTA, SC 29841-3067
(803) 279-6743
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.8561 GD
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8561
—
SC
Enumeration date
04/23/2016
Last updated
04/23/2016
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