MEDICARE: DR. JAMES MATTHEW CANDON III D.D.S

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	122300000X	Dentist	9104	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	:	1972951028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MATTHEW CANDON III D.D.S

Provider Business Mailing Address
First Line	:	2012 BRIDGEMILL DR STE 108
Second Line	:
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-9221
Country	:	US
Telephone Number	:	803-650-3925
Fax Number	:	803-650-3926

Provider Business Practice Location Address
First Line	:	2012 BRIDGEMILL DR STE 108
Second Line	:
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-9221
Country	:	US
Telephone Number	:	803-650-3925
Fax Number	:	803-650-3926

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

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	10/12/2021

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