Healthcare Provider Details

I. General information

NPI: 1285887208
Provider Name (Legal Business Name): EDWARD CHRISTOPHER DAVIS DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2842 SUNSET BLVD
WEST COLUMBIA SC
29169-3420
US

IV. Provider business mailing address

2842 SUNSET BLVD
WEST COLUMBIA SC
29169-3420
US

V. Phone/Fax

Practice location:
  • Phone: 803-739-1600
  • Fax: 803-739-9200
Mailing address:
  • Phone: 803-739-1600
  • Fax: 803-739-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3458
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: