Organization
SOUTH CAROLINA COMMUNITY DENTISTRY SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE BENITEZ (PRESIDENT)
(888) 344-0304
Entity
Organization
Contact information
Practice address
701 GERVAIS ST, #150-128, COLUMBIA, SC 29201-3066
(888) 344-0304
Mailing address
701 GERVAIS ST, #150-128, COLUMBIA, SC 29201-3066
(888) 344-0304
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9625
—
SC
Enumeration date
03/08/2007
Last updated
08/22/2020
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