Healthcare Provider Details

I. General information

NPI: 1194964676
Provider Name (Legal Business Name): DENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 FOLLY RD
CHARLESTON SC
29412
US

IV. Provider business mailing address

531 FOLLY RD
CHARLESTON SC
29412
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-1111
  • Fax: 843-795-8275
Mailing address:
  • Phone: 843-795-1111
  • Fax: 843-795-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3448
License Number StateSC

VIII. Authorized Official

Name: DR. ROBERT J. BEALL
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 843-795-1111