Healthcare Provider Details

I. General information

NPI: 1922499011
Provider Name (Legal Business Name): CHAPIN ORAL AND MAXILLOFACIAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ST. PETER'S CHURCH ROAD
CHAPIN SC
29036
US

IV. Provider business mailing address

112 ST. PETER'S CHURCH RD
CHAPIN SC
29036
US

V. Phone/Fax

Practice location:
  • Phone: 803-816-2795
  • Fax:
Mailing address:
  • Phone: 803-816-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7138
License Number StateSC

VIII. Authorized Official

Name: ADAM D. HAIRR
Title or Position: OWNER/PROVIDER
Credential: DDS
Phone: 803-816-2795