Organization
DENTAL PROFESSIONAL OF SC
Active
Parent organization
DENTAL PROFESSIONAL OF SC
Other names
South Aiken Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONAL OF SC
Authorized official
JEAN CORNELL (INSURANCE/CREDENTIALING)
(217) 540-5100
Entity
Organization
Contact information
Practice address
1055 PINE LOG RD, AIKEN, SC 29803-7396
(803) 761-7924
Mailing address
1055 PINE LOG RD, AIKEN, SC 29803-7396
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/19/2014
Last updated
02/19/2014
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