Peacock, Edgar Harold

Peacock, Edgar Harold is an sole proprietor health care provider with primary practice located at 2750 Laurel St Ste 202, Columbia SC 29204-2024. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Peacock, Edgar Harold can be contacted via phone (803) 256-9268.

Contact Information

Primary practice address
2750 Laurel St Ste 202 Columbia SC 29204-2024
Phone: (803) 256-9268
Fax: (803) 256-0084
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 1545 South Carolina

Profile Details

NPI number 1275536245
LBN Legal business name Peacock, Edgar Harold
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 24th, 2005
Last updated Mar 19th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275536245 NPPES
South Carolina MEDICAID Z15458
South Carolina MEDICAID ZA9549

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