Organization
UPSTATE ORAL & MAXILLOFACIAL SURGERY & DENTAL IMPLANT CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMER ATALLAH JOUDEH D.M.D. (OWNER)
(864) 855-0383
Entity
Organization
Contact information
Practice address
227 S PENDLETON ST, SUITE A, EASLEY, SC 29640-3047
(864) 855-0383
(864) 855-0390
Mailing address
227 S PENDLETON ST, SUITE A, EASLEY, SC 29640-3047
(864) 855-0383
(864) 855-0390
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629182506
NPI W. MICHAEL RIDDLE
SC
01
—
1730197641
NPI SAMER A. JOUDEH
SC
01
—
1780769307
NPI S. ANTHONY BOWIE
SC
05
—
ZG1698
—
SC
05
—
ZX3518
—
SC
05
—
ZZ1503
—
SC
Enumeration date
04/12/2007
Last updated
08/22/2020
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