Organization
EDISTO DENTAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLIFTON JORDAN III DDS (OWNER/DENTIST)
(803) 531-1601
Entity
Organization
Contact information
Practice address
2197 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-2038
(803) 531-1601
Mailing address
2197 ST. MATTHEW ROAD, ORANGEBURG, SC 29118
(803) 531-1601
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4010
SC
Other
Enumeration date
01/14/2008
Last updated
01/14/2008
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