Healthcare Provider Details

I. General information

NPI: 1164164513
Provider Name (Legal Business Name): ROGER ACCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 HILL ST
COLUMBIA SC
29207-6022
US

IV. Provider business mailing address

4323 HILL ST
COLUMBIA SC
29207-6022
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-1252
  • Fax:
Mailing address:
  • Phone: 803-751-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: