Organization
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Active
Parent organization
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Other names
Premier Dentistry of Blythewood
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF SOUTH CAROLINA, P.C.
Authorized official
KIM WILSON (CREDENTIALING COORDINATOR)
(217) 540-5170
Entity
Organization
Contact information
Practice address
213 MAIN STREET, BLYTHEWOOD, SC 29016-0589
(803) 754-9545
(803) 754-2158
Mailing address
PO BOX 589, BLYTHEWOOD, SC 29016-0589
(803) 754-9545
(803) 754-2158
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/02/2012
Last updated
04/02/2012
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