Organization
CLOVER FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST L MYRICK JR. D.M.D. (MEMBER)
(803) 222-4518
Entity
Organization
Contact information
Practice address
203 CHURCH ST, CLOVER, SC 29710-1008
(803) 222-4518
(803) 222-4598
Mailing address
203 CHURCH ST, CLOVER, SC 29710-1008
(803) 222-4518
(803) 222-4598
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1860
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z18605
—
SC
05
—
ZX4199
—
SC
Enumeration date
05/02/2007
Last updated
08/22/2020
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