Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3908 | SC |
NPI | 1104846534 |
---|---|
Provider Name | Dr. Thomas Edwin Porch |
First Address | Greenville, SC 29615-1049 |
Second Address | Columbia, SC 29209-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |