MEDICARE: FAMILY DENTISTRY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3496	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376683102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DENTISTRY, PC

Provider Business Mailing Address
First Line	:	427 DAVE LYLE BLVD S
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-4402
Country	:	US
Telephone Number	:	803-328-0858
Fax Number	:	803-324-7748

Provider Business Practice Location Address
First Line	:	427 DAVE LYLE BLVD S
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-4402
Country	:	US
Telephone Number	:	803-328-0858
Fax Number	:	803-324-7748

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. DOCK C. MCDUFFIE,III
Credential	:	D.D.S.
Telephone Number	:	803-328-0858

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	06/16/2008

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