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General NPI Number Information
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NPI Number | 1841583630
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Entity Type | Organization
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Legal Business Name | FOOTHILLS FAMILY DENTAL PA
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 206 ELLIOTT RD
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City | LYMAN
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State | SC
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Zip | 29365-1620
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Country | US
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Telephone | 864-439-6559
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Fax | 864-439-1905
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Provider Business Mailing Address
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Address Line | 206 ELLIOTT RD
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City | LYMAN
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State | SC
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Zip | 29365-1620
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Country | US
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Telephone | 864-439-6559
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Fax | 864-439-1905
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WILLIAM ARISTIDES MALONE
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Credential | DMD
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Telephone | 864-439-6559
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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 | 4711
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License Number State | SC
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