Providence Dental Group LLC
NPI #1760502181 in Simpsonville, South Carolina
Provider Information
- NPI Number
- 1760502181
- Entity Type
- Organization
- Organization Name
- Providence Dental Group LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Mar 30, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 220 BRIDGES RD
- City
- Simpsonville
- State
- South Carolina
- ZIP Code
- 29681-5700
- Phone
- (864) 675-6445
Authorized Official
- Name
- DR. JASON PHILLIP MAKOWSKI
- Title
- MEMBER
- Phone
- (864) 675-6445
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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