Healthcare Provider Details

I. General information

NPI: 1174086250
Provider Name (Legal Business Name): COLBY SHANE SOWERS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 SAM RITTENBERG BLVD
CHARLESTON SC
29407-4683
US

IV. Provider business mailing address

2051 SAM RITTENBERG BLVD
CHARLESTON SC
29407-4683
US

V. Phone/Fax

Practice location:
  • Phone: 843-779-6844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN24017
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN124059
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number11251
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: