Organization
ISSAQUEENA PEDIATRIC DENTISTRY P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAMILLE W HORTON DMD (PRESIDENT)
(864) 482-7900
Entity
Organization
Contact information
Practice address
314 UNION STATION DR, SENECA, SC 29678-4547
(864) 482-7900
(864) 482-7510
Mailing address
314 UNION STATION DR, SENECA, SC 29678-4547
(864) 482-7900
(864) 482-7510
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
4211
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588875934
—
SC
Enumeration date
09/26/2012
Last updated
09/26/2012
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