Healthcare Provider Details

I. General information

NPI: 1396652921
Provider Name (Legal Business Name): LOWCOUNTRY ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
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

974 HIGHWAY 321 N STE 104
LENOIR CITY TN
37771-2177
US

V. Phone/Fax

Practice location:
  • Phone: 865-381-8867
  • Fax: 865-419-0888
Mailing address:
  • Phone: 865-381-8867
  • Fax: 865-419-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

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