MEDICARE: SANDY SPRINGS DENTAL CLINIC

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	2744	SC

General Provider Information

NPI Number	:	1871794628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDY SPRINGS DENTAL CLINIC

Provider Business Mailing Address
First Line	:	5302 HIGHWAY 76
Second Line	:
City	:	PENDLETON
State	:	SC
Zip	:	29670-9139
Country	:	US
Telephone Number	:	864-261-3436
Fax Number	:

Provider Business Practice Location Address
First Line	:	5302 HWY 76
Second Line	:
City	:	PENDLETON
State	:	SC
Zip	:	29677-9139
Country	:	US
Telephone Number	:	864-261-3436
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JULIE CECELIA MARZOLF
Credential	:
Telephone Number	:	864-261-3436

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/22/2020

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