SOUTHERN ROOTS PERIODONTICS: IMPLANT & LASER DENTISTRY LLC NPI 1578009056

NPI Information

SOUTHERN ROOTS PERIODONTICS: IMPLANT & LASER DENTISTRY, LLC is a dental clinic center in Columbia, SC. SOUTHERN ROOTS PERIODONTICS: IMPLANT & LASER DENTISTRY, LLC NPI is 1578009056. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is South Carolina Periodontology.

The provider's business location address is:

2120 N BELTLINE BLVD
COLUMBIA, SC
ZIP 29204-518
Phone: (803) 782-0528
Fax: (803) 782-1036

The provider's authorized official is Matthew Joseph Rowe .
The authorized official title is Owner/manager and has the following contact phone number (803) 782-0528.

The enumeration date for this NPI number is 1/9/2017 and was last updated on 1/9/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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