Healthcare Provider Details

I. General information

NPI: 1205004520
Provider Name (Legal Business Name): SANTEE DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 B PLAZA CIRCLE
SANTEE SC
29142
US

IV. Provider business mailing address

190 B PLAZA CIRCLE
SANTEE SC
29142
US

V. Phone/Fax

Practice location:
  • Phone: 803-854-2600
  • Fax: 803-854-2660
Mailing address:
  • Phone: 803-854-2600
  • Fax: 803-854-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3524
License Number StateSC

VIII. Authorized Official

Name: DR. WILLIAM SCOTT GARRIS
Title or Position: OWNER
Credential: D.M.D.
Phone: 843-563-3208