Organization
COLUMBIA PERIODONTAL ASSOICATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAUREL-JEAN M MATHIS RDH (OFFICE MANAGER)
(803) 798-0894
Entity
Organization
Contact information
Practice address
3527 BUSH RIVER RD, COLUMBIA, SC 29210-4805
(803) 798-0894
(803) 731-7887
Mailing address
3527 BUSH RIVER RD, COLUMBIA, SC 29210-4805
(803) 798-0894
(803) 731-7887
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9736
—
SC
Enumeration date
07/24/2006
Last updated
08/22/2020
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