Organization
CENTRAL CAROLINA ENDODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH DAVIN BONAVILLA DDS (PRESIDENT)
(803) 516-0777
Entity
Organization
Contact information
Practice address
888 COOK ROAD, ORANGEBURG, SC 29118
(803) 516-0777
(803) 516-0577
Mailing address
888 COOK ROAD, ORANGEBURG, SC 29118
(803) 516-0777
(803) 516-0577
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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