Organization
LAKE BOWEN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ASA DUNCAN SHIRLEY III DMD (DENTIST/OWNER)
(864) 592-1647
Entity
Organization
Contact information
Practice address
8810 HWY 9, INMAN, SC 29349
(864) 592-1647
(864) 592-0630
Mailing address
PO BOX 38, INMAN, SC 29349
(864) 592-1647
(864) 592-0630
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
SC1228
SC
122300000X
Dentist
Primary
SC1863
SC
122300000X
Dentist
SC3766
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9600
—
SC
Enumeration date
09/16/2006
Last updated
08/22/2020
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