Healthcare Provider Details

I. General information

NPI: 1710178793
Provider Name (Legal Business Name): DDS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MEDICAL LN E SUITE 115
WEST COLUMBIA SC
29169-4817
US

IV. Provider business mailing address

110 MEDICAL LN E SUITE 115
WEST COLUMBIA SC
29169-4817
US

V. Phone/Fax

Practice location:
  • Phone: 803-739-4805
  • Fax: 803-739-4810
Mailing address:
  • Phone: 803-739-4805
  • Fax: 803-739-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2941
License Number StateSC

VIII. Authorized Official

Name: DR. JAMES E. MERCER
Title or Position: CEO
Credential: DDS
Phone: 803-739-4805