| Clemson Family Dentistry | |
|
875 Old Clemson Hwy Seneca SC 29672-8060 | |
| (864) 654-5733 | |
| (864) 654-1117 |
| Full Name | Clemson Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 875 Old Clemson Hwy, Seneca, South Carolina |
| Authorized Official Name and Position | Connie Hix Black (OFFICE MANAGER) |
| Authorized Official Contact | 8646545733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clemson Family Dentistry Po Box 349 Clemson SC 29633 Ph: (864) 654-5733 | Clemson Family Dentistry 875 Old Clemson Hwy Seneca SC 29672-8060 Ph: (864) 654-5733 |
| NPI Number | 1144234063 |
|---|---|
| Provider Enumeration Date | 07/28/2006 |
| Last Update Date | 07/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144234063 | NPI | - | NPPES |
| 122300000X | Other | SC | PROVIDER TAXONOMIES |
| 1223G0001X | Other | SC | PROVIDER TAXONOMIES |
| ZA9517 | Medicaid | SC | |
| ZX1738 | Medicaid | SC | |
| 3718 | Other | SC | SC LIC # |
| ZX3718 | Medicaid | SC | |
| 1738 | Other | SC | LIC# TN |
| 4110 | Other | SC | SC LIC # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3718SC (South Carolina) | Primary |
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