Organization
IMMEDIATE DENTAL GROUP COLUMBIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZACHARY TODD DAUGHERTY (BUSINESS MANAGER)
(910) 526-3487
Entity
Organization
Contact information
Practice address
1118 GREENLAWN DRIVE, COLUMBIA, SC 29209
(803) 807-2140
(803) 807-2141
Mailing address
1118 GREENLAWN DRIVE, COLUMBIA, SC 29209
(803) 807-2140
(803) 807-2141
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
SC2662
SC
Other
Enumeration date
11/06/2012
Last updated
11/06/2012
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