Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Pelion Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DELGADO CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
8063 EDMUND HWY, PELION, SC 29123-9805
(803) 894-3736
(803) 894-5315
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 753-5591
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9096
—
SC
Enumeration date
07/19/2016
Last updated
02/10/2022
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