Organization
IVY CREEK FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHERMAINE LATRICE LYDE DMD (OWNER/PARTNER)
(803) 302-4445
Entity
Organization
Contact information
Practice address
9007 TWO NOTCH RD STE B, COLUMBIA, SC 29223-5834
(803) 302-4445
Mailing address
337 OAKPOINTE LN, LEXINGTON, SC 29072-7232
(912) 695-8540
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/28/2020
Last updated
01/28/2020
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