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General NPI Number Information
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NPI Number | 1255560108
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Entity Type | Organization
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Legal Business Name | MOWLAJLO FAMILY AND COSMETIC DENTISTRY,LLC
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 07/13/2009
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Provider Practice Location Address
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Address Line | 205 E HIGHLAND AVE # AVW
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City | ANDERSON
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State | SC
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Zip | 29621-4711
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Country | US
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Telephone | 864-224-8831
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Fax | 864-244-8870
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Provider Business Mailing Address
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Address Line | 205 E HIGHLAND AVE
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City | ANDERSON
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State | SC
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Zip | 29621-4711
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Country | US
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Telephone | 864-224-8831
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Fax | 864-224-8870
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Authorized Official
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Title or Position | OWNER OF PRACTICE
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Name | MS. PATTI P MOWLAJKO
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Credential |
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Telephone | 864-224-8831
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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 |
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License Number State | SC
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