Provider Demographics
NPI:1467411397
Name:SCIOSCIA, PATRICK A (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:SCIOSCIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SALUDA SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6666
Mailing Address - Country:US
Mailing Address - Phone:803-951-7343
Mailing Address - Fax:803-951-2298
Practice Address - Street 1:230 SALUDA SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6666
Practice Address - Country:US
Practice Address - Phone:803-951-7343
Practice Address - Fax:803-951-2298
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ33072Medicaid
SCZ33072Medicaid