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General NPI Number Information
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NPI Number | 1942546817
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Entity Type | Organization
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Legal Business Name | FLORENCE DENTAL CARE, LLC
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Dates
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Enumeration Date | 12/21/2012
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Last Update Date | 12/21/2012
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Provider Practice Location Address
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Address Line | 1509 W PALMETTO ST
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City | FLORENCE
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State | SC
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Zip | 29501-4131
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Country | US
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Telephone | 864-200-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 W PALMETTO ST
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City | FLORENCE
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State | SC
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Zip | 29501-4131
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER/DENTIST
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Name | DR. JASON SCOTT ROGERS
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Credential | DMD
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Telephone | 864-200-1999
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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 | 4024
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License Number State | SC
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