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General NPI Number Information
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NPI Number | 1124320353
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Entity Type | Organization
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Legal Business Name | ADVANCED ENDODONTICS OF AIKEN PC
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 20 TEA OLIVE CT
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City | AIKEN
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State | SC
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Zip | 29803-7543
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Country | US
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Telephone | 803-648-0056
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Fax | 803-648-0057
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Provider Business Mailing Address
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Address Line | 20 TEA OLIVE COURT
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City | AIKEN
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State | SC
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Zip | 29803-7543
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Country | US
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Telephone | 803-648-0056
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Fax | 803-648-0057
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARGIE CERVANTES
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Credential |
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Telephone | 803-648-0056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 4058
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License Number State | SC
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