Dental Professionals Of South Carolina, PC
Dentist, General Practice in Indian Land, SC. Organization (NPI-2).
NPI number1871964015
StatusActive
Last updated in NPPESOct 14, 2015
Details
- NPI
- 1871964015
- Entity type
- Organization (NPI-2)
- Legal business name
- Dental Professionals Of South Carolina, PC
- Organization subpart
- Yes
- Enumeration date
- Oct 14, 2015
- Last updated
- Oct 14, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Edgewater Family Dental (Doing Business As)
Practice location
1028 Edgewater Corp. PkwySuite 101
Indian Land, SC 29707
Phone 803-399-7659
Mailing address
1028 Edgewater Corp. PkwySuite 101
Indian Land, SC 29707
Authorized official
Kendra Walker
Credentialing Coordinator
2175408312
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 21 General Practice Dentistry providers in Indian Land · All 308 providers in Indian Land
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