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General NPI Number Information
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NPI Number | 1689830226
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Entity Type | Individual
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Provider Name | CHERMAINE LATRICE LYDE DMD
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Gender | Female
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 8063 EDMUND HWY
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City | PELION
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State | SC
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Zip | 29123-9805
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Country | US
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Telephone | 803-894-3736
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Fax | 803-894-5315
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Provider Business Mailing Address
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Address Line | PO BOX 3788
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City | COLUMBIA
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State | SC
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Zip | 29230-3788
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Country | US
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Telephone | 803-733-5969
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Fax | 803-753-5591
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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 | 4423
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License Number State | SC
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