Organization
SUNSET PERIODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS WAYNE MIZE D.M.D., M.H.S. (OWNER)
(317) 345-3113
Entity
Organization
Contact information
Practice address
159 MEDICAL CIR, WEST COLUMBIA, SC 29169-3655
(803) 794-7520
Mailing address
159 MEDICAL CIR, WEST COLUMBIA, SC 29169-3655
(803) 794-7520
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
826
SC
Other
Enumeration date
04/30/2015
Last updated
06/04/2015
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