Organization
MEDICAID DENTAL PRACTICE OF EASLEY, SC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN C EDWARDS DDS (PRESIDENT)
(864) 859-0111
Entity
Organization
Contact information
Practice address
807 S PENDLETON ST, EASLEY, SC 29640-3527
(864) 855-6530
Mailing address
415 S PENDLETON ST, EASLEY, SC 29640-3072
(864) 859-0111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3944
SC
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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