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General NPI Number Information
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NPI Number | 1598967259
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Entity Type | Individual
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Provider Name | FREDERICK EARLE BROGDON JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 634 BULTMAN DR
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City | SUMTER
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State | SC
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Zip | 29150-2550
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Country | US
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Telephone | 803-775-4368
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Fax | 803-775-1268
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Provider Business Mailing Address
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Address Line | 460 PRINGLE DR
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City | SUMTER
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State | SC
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Zip | 29150-3235
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Country | US
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Telephone | 803-775-3440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2156
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License Number State | SC
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