| Clover Family Dentistry, Llc | |
|
203 Church St Clover SC 29710-1008 | |
| (803) 222-4518 | |
| (803) 222-4598 |
| Full Name | Clover Family Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 203 Church St, Clover, South Carolina |
| Authorized Official Name and Position | Ernest L Myrick (MEMBER) |
| Authorized Official Contact | 8032224518 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clover Family Dentistry, Llc 203 Church St Clover SC 29710-1008 Ph: (803) 222-4518 | Clover Family Dentistry, Llc 203 Church St Clover SC 29710-1008 Ph: (803) 222-4518 |
| NPI Number | 1346461563 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346461563 | NPI | - | NPPES |
| ZX4199 | Medicaid | SC | |
| Z18605 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1860 (South Carolina) | Primary |
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