Provider Demographics
NPI:1487890299
Name:CAMBRIDGE DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:CAMBRIDGE DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-229-5885
Mailing Address - Street 1:303 W ALEXANDER AVE
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4078
Mailing Address - Country:US
Mailing Address - Phone:864-229-5885
Mailing Address - Fax:864-229-1002
Practice Address - Street 1:303 W ALEXANDER AVE
Practice Address - Street 2:SUITE D-1
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4078
Practice Address - Country:US
Practice Address - Phone:864-229-5885
Practice Address - Fax:864-229-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty