Healthcare Provider Details

I. General information

NPI: 1326177122
Provider Name (Legal Business Name): TARIQ JAVED D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 ASHLEY AVE 343 BSB
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

PO BOX 250507 173 ASHLEY AVE.
CHARLESTON SC
29425-0507
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2344
  • Fax: 843-792-1521
Mailing address:
  • Phone: 843-792-2344
  • Fax: 843-792-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2585
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: