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General NPI Number Information
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NPI Number | 1912017997
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Entity Type | Organization
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Legal Business Name | DENTAL ASSOCIATES OF SOUTH CAROLINA, INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 104 BUFORD AVE
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City | ANDERSON
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State | SC
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Zip | 29621-3314
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Country | US
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Telephone | 864-224-1925
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Fax |
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Provider Business Mailing Address
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Address Line | 104 BUFORD AVE
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City | ANDERSON
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State | SC
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Zip | 29621-3314
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Country | US
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Telephone | 864-224-1925
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Fax |
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Authorized Official
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Title or Position | CORPORATE OFFICER
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Name | DR. KENDON A ROSS
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Credential | D.D.S.
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Telephone | 864-224-1925
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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 | 3260
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3286
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License Number State | SC
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