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NPI Code Detail

MEDICARE: DR. SHMUEL DABUSH DDS

MEDICARE: DR. SHMUEL DABUSH DDS
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
1122300000XDentist9970KY
2122300000XDentist10148SC
31223G0001XGeneral Practice Dentistry9970KY
41223P0221XPediatric Dentistry10284SC

General Provider Information

NPI Number : 1619407053
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHMUEL DABUSH DDS
Provider Business Mailing Address
First Line : 1617 DRYDEN LN
Second Line :
City : CHARLESTON
State : SC
Zip : 29407-3907
Country : US
Telephone Number : 843-801-4264
Fax Number : 843-343-8173
Provider Business Practice Location Address
First Line : 996 TANNER FORD BLVD
Second Line :
City : HANAHAN
State : SC
Zip : 29410-4780
Country : US
Telephone Number : 843-212-8810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2017
Last Update Date : 07/08/2022

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