| Carolina Forest Periodontics, Pa | |
|
1074 Highway 501 Business Conway SC 29526-9588 | |
| (843) 650-8000 | |
| (843) 347-4920 |
| Full Name | Carolina Forest Periodontics, Pa |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 1074 Highway 501 Business, Conway, South Carolina |
| Authorized Official Name and Position | Allen Rasheed (PRESIDENT) |
| Authorized Official Contact | 8436508000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolina Forest Periodontics, Pa 1074 Highway 501 Business Conway SC 29526-9588 Ph: (843) 650-8000 | Carolina Forest Periodontics, Pa 1074 Highway 501 Business Conway SC 29526-9588 Ph: (843) 650-8000 |
| NPI Number | 1063639888 |
|---|---|
| Provider Enumeration Date | 04/20/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063639888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 2434 (South Carolina) | Primary |
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