Healthcare Provider Details

I. General information

NPI: 1487712535
Provider Name (Legal Business Name): OAK POINT PEDIATRIC DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 OAK POINT RD
CHARLESTON SC
29412-2838
US

IV. Provider business mailing address

1721 OAK POINT RD
CHARLESTON SC
29412-2838
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-8787
  • Fax: 843-795-8717
Mailing address:
  • Phone: 843-795-8787
  • Fax: 843-795-8717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3467
License Number StateSC

VIII. Authorized Official

Name: DR. ERIN LEWIS NICHOLS
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 843-795-8787