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General NPI Number Information
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NPI Number | 1841373248
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Entity Type | Organization
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Legal Business Name | SUMTER FAMILY DENTAL CENTER
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 852 W LIBERTY ST
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City | SUMTER
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State | SC
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Zip | 29150-4729
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Country | US
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Telephone | 803-773-3328
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Fax | 803-773-9601
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Provider Business Mailing Address
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Address Line | 852 W LIBERTY ST
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City | SUMTER
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State | SC
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Zip | 29150-4729
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Country | US
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Telephone | 803-773-3328
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Fax | 803-773-9601
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDDIE C DURANT
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Credential | D.D.S.
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Telephone | 803-773-3328
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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 | 1682
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License Number State | SC
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