Healthcare Provider Details

I. General information

NPI: 1700848827
Provider Name (Legal Business Name): STEPHEN EDWARD CLARY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9310 TWO NOTCH RD NORTHEAST ORAL SURGERY
COLUMBIA SC
29223-6416
US

IV. Provider business mailing address

9310 TWO NOTCH RD NORTHEAST ORAL SURGERY
COLUMBIA SC
29223-6416
US

V. Phone/Fax

Practice location:
  • Phone: 803-699-5900
  • Fax: 803-788-9036
Mailing address:
  • Phone: 803-699-5900
  • Fax: 803-788-9036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7629
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4453 772 OS
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: