| Powdersville Pediatric Dentistry, Pa | |
|
10705 Anderson Road Easley SC 29642 | |
| (864) 220-5437 | |
| (864) 220-0420 |
| Full Name | Powdersville Pediatric Dentistry, Pa |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 10705 Anderson Road, Easley, South Carolina |
| Authorized Official Name and Position | Melanie Richards (OWNER PRESIDENT) |
| Authorized Official Contact | 8642205437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Powdersville Pediatric Dentistry, Pa 10705 Anderson Road Easley SC 29642 Ph: (864) 220-5437 | Powdersville Pediatric Dentistry, Pa 10705 Anderson Road Easley SC 29642 Ph: (864) 220-5437 |
| NPI Number | 1417965922 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 09/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417965922 | NPI | - | NPPES |
| 88009615 | Other | AL | BLUE CROSS BLUE SHIELD |
| 706109 | Other | UNITED CONCORDIA | |
| 214665 | Other | ANTHEM BLUE CROSS | |
| 3126152 | Other | TN | BLUE CROSS BLUE SHIELD |
| ZA9574 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 3152 (South Carolina) | Primary |
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