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General NPI Number Information
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NPI Number | 1588772008
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Entity Type | Organization
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Legal Business Name | FOOTBRIDGE FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 1122 HIGHWAY 86
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City | PIEDMONT
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State | SC
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Zip | 29673-8904
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Country | US
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Telephone | 864-845-3402
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Fax | 864-845-3101
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | PIEDMONT
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State | SC
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Zip | 29673-0218
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Country | US
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Telephone | 864-845-3402
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Fax | 864-845-3101
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | MRS. JULIE R WEATHERS
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Credential |
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Telephone | 864-845-3402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3866
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License Number State | SC
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