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General NPI Number Information
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NPI Number | 1902167307
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Entity Type | Organization
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Legal Business Name | SPARTANBURG ENDODONTIC ASSOCIATES PA
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 154 COUNTRY CLUB RD
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City | SPARTANBURG
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State | SC
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Zip | 29302-3364
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Country | US
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Telephone | 864-582-0332
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Fax | 864-582-2263
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Provider Business Mailing Address
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Address Line | 154 COUNTRY CLUB RD
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City | SPARTANBURG
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State | SC
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Zip | 29302-3364
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Country | US
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Telephone | 864-582-0332
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Fax | 864-582-2263
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Authorized Official
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Title or Position | PRESIDENT-SPARTANBURG ENDODONTIC AS
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Name | DR. WILLIAM MILLER EDWARDS
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Credential | DMD
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Telephone | 864-582-0332
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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 | 1845
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License Number State | SC
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