Organization
JOHN G MCROBERTS DMD PA
Active
Parent organization
JOHN G MCROBERTS DMD PA
Other names
Clemson Family Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
JOHN G MCROBERTS DMD PA
Authorized official
CONNIE HIX BLACK (OFFICE MANAGER)
(864) 654-5733
Entity
Organization
Contact information
Practice address
875 OLD CLEMSON HWY, SENECA, SC 29672-8060
(864) 654-5733
(864) 654-1117
Mailing address
PO BOX 349, CLEMSON, SC 29633
(864) 654-5733
(864) 654-1117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3718SC
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122300000X
PROVIDER TAXONOMIES
SC
01
—
1223G0001X
PROVIDER TAXONOMIES
SC
01
—
1738
LIC# TN
SC
01
—
3718
SC LIC #
SC
01
—
4110
SC LIC #
SC
05
—
ZA9517
—
SC
05
—
ZX1738
—
SC
05
—
ZX3718
—
SC
Enumeration date
07/28/2006
Last updated
07/14/2008
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