Ancient Mariner, LLC
NPI #1225456247 in Columbia, South Carolina
Provider Information
- NPI Number
- 1225456247
- Entity Type
- Organization
- Organization Name
- Ancient Mariner, LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Apr 7, 2014
- Last Updated
- Oct 27, 2015
Practice Location
- Address
- 1118 GREENLAWN DR
- City
- Columbia
- State
- South Carolina
- ZIP Code
- 29209-2606
- Phone
- (803) 807-2140
Authorized Official
- Name
- TONIA PATTERSON
- Title
- OFFICE ADMINISTRATOR
- Phone
- (803) 600-7211
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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