Organization
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Active
Parent organization
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Other names
Dental Care of Lake Wylie
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Authorized official
KENDRA WALKER (CREDENTIALING TEAM LEAD)
(217) 540-8312
Entity
Organization
Contact information
Practice address
209 LATITUDE LANE, CLOVER, SC 29710
(803) 619-4511
(803) 619-4586
Mailing address
209 LATITUDE LANE, CLOVER, SC 29710
(803) 619-4511
(803) 619-4586
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/31/2016
Last updated
01/09/2017
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