MEDICARE: ASHLEY RIVER COMPREHENSIVE FAMILY DENTISTRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	SC 3961	SC

General Provider Information

NPI Number	:	1568540979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEY RIVER COMPREHENSIVE FAMILY DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	2060 CHARLIE HALL BLVD
Second Line	:	SUITE 5A
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5830
Country	:	US
Telephone Number	:	843-763-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 CHARLIE HALL BLVD
Second Line	:	SUITE 5A
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5830
Country	:	US
Telephone Number	:	843-763-5665
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DR. SUZANNE M ABEL
Credential	:	PHD
Telephone Number	:	843-763-5665

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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