Organization · Type 2 NPI
Dutch Fork Family Dentistry, PA
Dental Clinic/Center · Irmo, SC
NPI number
1104166792
Active
Practice location
7436 Broad River Rd Ste 111
Irmo, SC 29063-7601
Fax (803) 749-3335
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dental Clinic/Center Primary | 261QD0000X | 4654 (SC) |
Dental Clinic/Center: Definition to come...
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About NPI 1104166792
Dutch Fork Family Dentistry, PA's National Provider Identifier is 1104166792, issued on Feb 19, 2013. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Irmo, SC. The record was last updated on Feb 19, 2013.