Organization Name: | VICTORY DENTAL CENTER, LLC |
NPI Number: | 1154657229 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CEDRICK BROWN MCDONALD (DENTIST/OWNER) |
Mailing Address: | 9787 Charlotte Highway Suite 201 Indian Land |
State: | SC US |
Postal Code: | 297075511 |
Phone Number: | 8035799775 |
Fax Number: | |
NPI Enumeration Date: | 10/26/2009 |
NPI Last Update Date: | 03/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 4382 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |