MEDICARE: CHARLES MIDDLETON ANDERSON DMD

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	122300000X	Dentist	2694	SC
2	1223G0001X	General Practice Dentistry	2694	SC

General Provider Information

NPI Number	:	1952515637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MIDDLETON ANDERSON DMD

Provider Business Mailing Address
First Line	:	317 WINGO WAY
Second Line	:	SUITE 301
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-1803
Country	:	US
Telephone Number	:	843-884-2021
Fax Number	:	843-884-6910

Provider Business Practice Location Address
First Line	:	317 WINGO WAY
Second Line	:	SUITE 301
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-1803
Country	:	US
Telephone Number	:	843-884-2021
Fax Number	:	843-884-6910

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	09/11/2025

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Directions to “ CHARLES MIDDLETON ANDERSON DMD” Practice Location

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