Healthcare Provider Details

I. General information

NPI: 1598856353
Provider Name (Legal Business Name): SOUTH CAROLINA PERIODONTOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N BELTLINE BOULEVARD
COLUMBIA SC
29204-3905
US

IV. Provider business mailing address

2120 N BELTLINE BOULEVARD
COLUMBIA SC
29204-3905
US

V. Phone/Fax

Practice location:
  • Phone: 803-782-0528
  • Fax: 803-782-1036
Mailing address:
  • Phone: 803-782-0528
  • Fax: 803-782-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM CLEVELAND JAMES JR.
Title or Position: OWNER
Credential: DDS
Phone: 803-782-0528