Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 59 | SC |
NPI | 1063637379 |
---|---|
Provider Name | Dr. Edward Mccallum |
First Address | Greenwood, SC 29649 |
Second Address | Greenwood, SC 29649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |