Organization
MIDLANDS ORAL AND MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE M MONTES (INSURANCE COORDINATOR)
(803) 254-2972
Entity
Organization
Contact information
Practice address
1755 SAINT JULIAN PL, COLUMBIA, SC 29204-2409
(803) 254-2972
(803) 799-2151
Mailing address
1755 SAINT JULIAN PL, COLUMBIA, SC 29204-2409
(803) 254-2972
(803) 799-2151
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1788
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9935
—
SC
Enumeration date
05/23/2006
Last updated
08/22/2020
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