Organization
ANDERSON ORAL AND MAXILLOFACIAL SURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEWIS TYLER SUMNER D.M.D. (PHYSICIAN/ OWNER)
(864) 226-7503
Entity
Organization
Contact information
Practice address
1209 ELLA STREET, ANDERSON, SC 29621
(864) 226-7503
(864) 225-4937
Mailing address
1209 ELLA STREET, ANDERSON, SC 29621
(864) 226-7503
(864) 225-4937
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3483
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9686
—
SC
Enumeration date
02/22/2007
Last updated
12/06/2013
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