Organization
ANDERSON PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN WILCOX MONN DMD (PRESIDENT)
(864) 884-6522
Entity
Organization
Contact information
Practice address
198 MUTUAL DR, ANDERSON, SC 29621-1767
(864) 884-6522
Mailing address
35 WILLOW OAK CT, SIMPSONVILLE, SC 29681-4999
(864) 884-6522
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3818
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX3818
—
SC
Enumeration date
02/18/2011
Last updated
02/18/2011
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