| Organization Name: | UPSTATE PERIODONTICS, PA |
| NPI Number: | 1386859262 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID CHRISTOPHER GARRISON (PERIODONTIST) |
| Mailing Address: | 214 Frontage Rd Clemson |
| State: | SC US |
| Postal Code: | 296311642 |
| Phone Number: | 8646543416 |
| Fax Number: | 8646543384 |
| NPI Enumeration Date: | 05/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2267 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |