Healthcare Provider Details

I. General information

NPI: 1437797495
Provider Name (Legal Business Name): JEFFREY C KOTZ DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 SAINT ANDREWS BLVD STE C
CHARLESTON SC
29407-7148
US

IV. Provider business mailing address

846 SAINT ANDREWS BLVD STE C
CHARLESTON SC
29407-7148
US

V. Phone/Fax

Practice location:
  • Phone: 843-225-9002
  • Fax: 843-695-6995
Mailing address:
  • Phone: 843-225-9002
  • Fax: 843-695-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY CLAYTON KOTZ
Title or Position: PRESIDENT
Credential: DMD
Phone: 843-225-9002