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General NPI Number Information
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NPI Number | 1689679706
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Entity Type | Individual
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Provider Name | PAUL R MACO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 4590 STROM THURMOND BLVD
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City | COLUMBIA
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State | SC
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Zip | 29207-5305
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Country | US
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Telephone | 803-751-5178
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Fax |
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Provider Business Mailing Address
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Address Line | 4323 CHAMPION HILL ST
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City | COLUMBIA
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State | SC
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Zip | 29207-6022
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Country | US
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Telephone | 803-751-1624
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019021190
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License Number State | IL
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