Healthcare Provider Details

I. General information

NPI: 1205873114
Provider Name (Legal Business Name): EDWARD R STRAUSS DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WAPPOO CREEK DR SUITE 2-B
CHARLESTON SC
29412-2135
US

IV. Provider business mailing address

109 WAPPOO CREEK DR SUITE 2-B
CHARLESTON SC
29412-2135
US

V. Phone/Fax

Practice location:
  • Phone: 843-762-9028
  • Fax: 843-762-9030
Mailing address:
  • Phone: 843-762-9028
  • Fax: 843-762-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4006
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: