Organization Name: | G. THOMAS BRYCE, JR., DDS PA |
NPI Number: | 1003050568 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GORDON THOMAS BRYCE (OWNER) |
Mailing Address: | 1509 W Palmetto St Florence |
State: | SC US |
Postal Code: | 295014131 |
Phone Number: | 8436628413 |
Fax Number: | 8436622672 |
NPI Enumeration Date: | 04/28/2009 |
NPI Last Update Date: | 04/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 1217 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |