Organization
SUMTER ORAL & MAXILLOFACIAL SURGERY PA
Active
Other names
Dental Implant Center of Sumter
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A MCGINNIS DDS (OWNER)
(803) 905-4404
Entity
Organization
Contact information
Practice address
1210 WILSON HALL RD, SUMTER, SC 29150-1889
(803) 905-4404
(803) 905-4406
Mailing address
1210 WILSON HALL RD, SUMTER, SC 29150-1889
(803) 905-4404
(803) 905-4406
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3273
SC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
474
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
872701
UNITED CONCORDIA
—
01
—
88003121
BLUE CROSS BLUE SHIELD
AL
05
—
ZA9858
—
SC
01
—
ZDK433
BLUE CROSS BLUE SHIELD
MA
Enumeration date
04/11/2006
Last updated
01/14/2011
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