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General NPI Number Information
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NPI Number | 1144234063
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Entity Type | Organization
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Legal Business Name | JOHN G MCROBERTS DMD PA
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 875 OLD CLEMSON HWY
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City | SENECA
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State | SC
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Zip | 29672-8060
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Country | US
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Telephone | 864-654-5733
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Fax | 864-654-1117
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Provider Business Mailing Address
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Address Line | PO BOX 349
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City | CLEMSON
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State | SC
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Zip | 29633
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Country | US
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Telephone | 864-654-5733
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Fax | 864-654-1117
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CONNIE HIX BLACK
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Credential |
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Telephone | 864-654-5733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3718SC
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License Number State | SC
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