Healthcare Provider Details

I. General information

NPI: 1932010683
Provider Name (Legal Business Name): LOWCOUNTRY ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 843-604-4558
  • Fax: 864-403-7537
Mailing address:
  • Phone: 843-604-4558
  • Fax: 864-403-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. OTTO SLATER
Title or Position: OWNER
Credential: DDS
Phone: 865-381-8867