Organization
KENLEY LOFTIS D.M.D PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENLEY JACKSON LOFTIS D. M.D (OWNER)
(803) 794-8741
Entity
Organization
Contact information
Practice address
1101 B AVE, WEST COLUMBIA, SC 29169-6722
(803) 794-8741
(803) 794-2149
Mailing address
1101 B AVE, WEST COLUMBIA, SC 29169-6722
(803) 794-8741
(803) 794-2149
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3331
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z3331
—
SC
Enumeration date
03/05/2007
Last updated
09/23/2010
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