Healthcare Provider Details

I. General information

NPI: 1093905473
Provider Name (Legal Business Name): ALVIN H DANENBERG, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 SUNSET BLVD
WEST COLUMBIA SC
29169-3428
US

IV. Provider business mailing address

3244 SUNSET BLVD
WEST COLUMBIA SC
29169-3428
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-7543
  • Fax:
Mailing address:
  • Phone: 803-796-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1985
License Number StateSC

VIII. Authorized Official

Name: ALVIN H DANENBERG
Title or Position: PRESIDENT
Credential: DDS
Phone: 803-796-7543