| Eastside Family Dentistry Pa | |
|
3620 East River St Anderson SC 29621-7334 | |
| (864) 261-3132 | |
| (864) 261-6614 |
| Full Name | Eastside Family Dentistry Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3620 East River St, Anderson, South Carolina |
| Authorized Official Name and Position | Stanley Waring Sheftall (PRESIDENT) |
| Authorized Official Contact | 8642613132 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Family Dentistry Pa 3620 East River St Anderson SC 29621-7334 Ph: (864) 261-3132 | Eastside Family Dentistry Pa 3620 East River St Anderson SC 29621-7334 Ph: (864) 261-3132 |
| NPI Number | 1548363591 |
|---|---|
| Provider Enumeration Date | 09/06/2006 |
| Last Update Date | 08/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548363591 | NPI | - | NPPES |
| 2X2891 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2891 (South Carolina) | Primary |
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