MEDICARE: THERESA ADRY JOSEPH DMD

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	10258	SC

General Provider Information

NPI Number	:	1861182644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA ADRY JOSEPH DMD

Provider Business Mailing Address
First Line	:	1811 FAIR ST
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-2720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 MONUMENT SQ
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-3529
Country	:	US
Telephone Number	:	803-432-7626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/15/2023

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Directions to “ THERESA ADRY JOSEPH DMD” Practice Location

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