Medicaid Dental Practice of Easley, Sc, INC
NPI #1932399862 in Easley, South Carolina
Provider Information
- NPI Number
- 1932399862
- Entity Type
- Organization
- Organization Name
- Medicaid Dental Practice of Easley, Sc, INC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jul 26, 2007
- Last Updated
- Jul 26, 2007
Practice Location
- Address
- 807 S PENDLETON ST
- City
- Easley
- State
- South Carolina
- ZIP Code
- 29640-3527
- Phone
- (864) 855-6530
Authorized Official
- Name
- DR. SHAWN C EDWARDS, DDS
- Title
- PRESIDENT
- Phone
- (864) 859-0111
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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