MEDICARE: MS. SANDRA LEIGH CARSWELL RDH

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	124Q00000X	Dental Hygienist	1437	SC

General Provider Information

NPI Number	:	1912088485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA LEIGH CARSWELL RDH

Provider Business Mailing Address
First Line	:	3015 EDENVALE ROAD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29455
Country	:	US
Telephone Number	:	843-559-6321
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 WAPPOO CREEK DR
Second Line	:	SUITE 5
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2136
Country	:	US
Telephone Number	:	843-762-1234
Fax Number	:	843-762-9142

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	10/02/2007

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