| Victory Dental Center, Llc | |
|
9787 Charlotte Highway Suite 201 Indian Land SC 29707-5511 | |
| (803) 579-9775 | |
| Not Available |
| Full Name | Victory Dental Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9787 Charlotte Highway, Indian Land, South Carolina |
| Authorized Official Name and Position | Cedrick Brown Mcdonald (DENTIST/OWNER) |
| Authorized Official Contact | 8035472280 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Dental Center, Llc 9787 Charlotte Highway Suite 201 Indian Land SC 29707-5511 Ph: (803) 547-2280 | Victory Dental Center, Llc 9787 Charlotte Highway Suite 201 Indian Land SC 29707-5511 Ph: (803) 579-9775 |
| NPI Number | 1154657229 |
|---|---|
| Provider Enumeration Date | 10/26/2009 |
| Last Update Date | 03/20/2015 |
| Medicare PECOS PAC ID | 6800034646 |
|---|---|
| Medicare Enrollment ID | O20130606000059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154657229 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 4382 (South Carolina) | Primary |
| Provider Name | Cedrick B Mcdonald |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1811197460 PECOS PAC ID: 2163660903 Enrollment ID: I20130606000072 |
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