MEDICARE: CEDAR SPRING FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2651	SC
2	122300000X	Dentist	8255	SC

General Provider Information

NPI Number	:	1205280351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR SPRING FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	270 CEDAR SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-4654
Country	:	US
Telephone Number	:	864-583-4962
Fax Number	:	864-583-6333

Provider Business Practice Location Address
First Line	:	270 CEDAR SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-4654
Country	:	US
Telephone Number	:	864-583-4962
Fax Number	:	864-583-6333

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. STEVEN RICHARDS
Credential	:	DMD
Telephone Number	:	864-583-4962

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	04/14/2016

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Directions to “CEDAR SPRING FAMILY DENTISTRY ” Practice Location

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