Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Eau Claire Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DELGAOD CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
3800 N MAIN ST, STE. C, COLUMBIA, SC 29203-6414
(803) 705-3169
(803) 705-3175
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 753-5591
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9183
—
SC
Enumeration date
01/09/2015
Last updated
02/03/2022
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