| Azalea Dental Llc | |
|
310 N Gum St Ste B Summerville SC 29483-6874 | |
| (843) 216-9754 | |
| (843) 216-9756 |
| Full Name | Azalea Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 310 N Gum St Ste B, Summerville, South Carolina |
| Authorized Official Name and Position | Thomas Patrick Riley (DENTIST AND OWNER) |
| Authorized Official Contact | 8432619754 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Azalea Dental Llc 310 N Gum St Ste B Summerville SC 29483-6874 Ph: (843) 216-9754 | Azalea Dental Llc 310 N Gum St Ste B Summerville SC 29483-6874 Ph: (843) 216-9754 |
| NPI Number | 1568678407 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 07/17/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568678407 | NPI | - | NPPES |
| ZX03580 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3580 (South Carolina) | Primary |
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