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General NPI Number Information
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NPI Number | 1336814326
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Entity Type | Organization
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Legal Business Name | UPSTATE PERIODONTICS AND IMPLANTOLOGY, LLC
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 101 BEVERLY DR
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City | SENECA
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State | SC
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Zip | 29672-2487
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Country | US
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Telephone | 864-882-8900
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Fax | 864-882-8902
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Provider Business Mailing Address
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Address Line | 101 BEVERLY DR
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City | SENECA
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State | SC
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Zip | 29672-2487
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Country | US
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Telephone | 864-882-8900
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Fax | 864-882-8902
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | DR. JOSHUA AIKEN MCKEE
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Credential | DMD
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Telephone | 864-973-3418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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