Organization
ADVANCED ORAL & FACIAL SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARGIE CERVANTES (ADMINISTRATION)
(803) 648-0056
Entity
Organization
Contact information
Practice address
20 TEA OLIVE CT, AIKEN, SC 29803-4715
(803) 648-0056
(803) 648-0057
Mailing address
20 TEA OLIVE CT, AIKEN, SC 29803-4715
(803) 648-0056
(803) 648-0057
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6955
SC
Other
Enumeration date
12/15/2016
Last updated
12/15/2016
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