Healthcare Provider Details

I. General information

NPI: 1952353732
Provider Name (Legal Business Name): JAMES WINSTON STRIDER JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9310 TWO NOTCH ROAD
COLUMBIA SC
29223
US

IV. Provider business mailing address

9310 TWO NOTCH ROAD
COLUMBIA SC
29223
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 TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2143
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number60225
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN012316
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6415
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: