Organization
NORTHEAST ORAL & MAXILLOFACIAL SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EVELYN NITKA (OFFICE MANAGER)
(803) 699-5900
Entity
Organization
Contact information
Practice address
9310 TWO NOTCH RD, COLUMBIA, SC 29223-6416
(803) 699-5900
(803) 788-9036
Mailing address
9310 TWO NOTCH RD, COLUMBIA, SC 29223-6416
(803) 699-5900
(803) 788-9036
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
3160
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9919
—
SC
Enumeration date
03/07/2007
Last updated
08/22/2020
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