Organization
MCCALLUM ORTHODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST J MCCALLUM DDS (PRESIDENT)
(864) 229-1601
Entity
Organization
Contact information
Practice address
608 CALHOUN AVE, GREENWOOD, SC 29649
(864) 229-1611
Mailing address
608 CALHOUN AVE, GREENWOOD, SC 29649
(864) 229-1611
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
SC ORTHO 448
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZA9640
GROUP MEDICAID
—
05
—
ZX3175
—
SC
Enumeration date
01/17/2007
Last updated
08/22/2020
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