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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
1055 PINE LOG RD, AIKEN, SC 29803-7396
(803) 226-9244
Mailing address
1055 PINE LOG RD, AIKEN, SC 29803-7396
(478) 319-5535

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.9829
SC
1223G0001X
General Practice Dentistry
DN016064
GA

Other

Enumeration date
06/16/2020
Last updated
02/16/2024
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