Organization
CAROLINA PERIODONTICS & DENTAL IMPLANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWNA BAXTER (PERIODONTIST/OWNER)
(480) 289-0507
Entity
Organization
Contact information
Practice address
112 W BROAD ST UNIT 405, GREENVILLE, SC 29601-2688
(480) 289-0507
Mailing address
112 W BROAD ST UNIT 405, GREENVILLE, SC 29601-2688
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
8638
SC
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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