Distinctive Dentistry
Dentist, General Practice in Irmo, SC. Organization (NPI-2).
NPI number1760664304
StatusActive
Last updated in NPPESDec 5, 2007
Details
- NPI
- 1760664304
- Entity type
- Organization (NPI-2)
- Legal business name
- Distinctive Dentistry
- Organization subpart
- No
- Enumeration date
- Dec 5, 2007
- Last updated
- Dec 5, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 4114 | SC | Yes |
Practice location
11107 Broad River RdSuite D
Irmo, SC 29063-7602
Phone 803-749-3980 · Fax 803-749-3981
Mailing address
11107 Broad River RdSuite D
Irmo, SC 29063-7602
Phone 803-749-3980 · Fax 803-749-3981
Authorized official
Robert Ray Cunningham
Owner
8039176962
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All 29 General Practice Dentistry providers in Irmo · All 835 providers in Irmo
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