Organization
EDISTO DENTAL ASSOCIATES OF SC, LLC
Active
Other names
J. Michael Havird, DMD, PC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE CORLEY (OFFICE MANAGER)
(803) 279-0015
Entity
Organization
Contact information
Practice address
51 STATION CT STE C, EDISTO ISLAND, SC 29438-3020
(843) 869-3368
Mailing address
PO BOX 218, EDISTO ISLAND, SC 29438-0218
(843) 869-3368
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
2109
SC
Other
Enumeration date
08/20/2008
Last updated
08/20/2008
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