Provider Demographics
NPI:1841373248
Name:SUMTER FAMILY DENTAL CENTER
Entity type:Organization
Organization Name:SUMTER FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DURANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-773-3328
Mailing Address - Street 1:852 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4729
Mailing Address - Country:US
Mailing Address - Phone:803-773-3328
Mailing Address - Fax:803-773-9601
Practice Address - Street 1:852 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4729
Practice Address - Country:US
Practice Address - Phone:803-773-3328
Practice Address - Fax:803-773-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty