Healthcare Provider Details

I. General information

NPI: 1255450110
Provider Name (Legal Business Name): ASSOCIATES IN ORAL & MAXILLOFACIAL SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SALUDA RIDGE CT SUITE 400
WEST COLUMBIA SC
29169-3460
US

IV. Provider business mailing address

7033 SAINT ANDREWS RD SUITE 102
COLUMBIA SC
29212-1179
US

V. Phone/Fax

Practice location:
  • Phone: 803-781-3321
  • Fax: 803-781-4406
Mailing address:
  • Phone: 803-781-3321
  • Fax: 803-781-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES E. MERCER
Title or Position: PRES
Credential: DDS
Phone: 803-781-3321