Healthcare Provider Details

I. General information

NPI: 1164346086
Provider Name (Legal Business Name): DENTAL VISTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 SAVANNAH HWY STE 2
CHARLESTON SC
29407-7842
US

IV. Provider business mailing address

1575 SAVANNAH HWY STE 2
CHARLESTON SC
29407-7842
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-4999
  • Fax:
Mailing address:
  • Phone: 843-766-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: INESHA VONIQUE BAKER
Title or Position: DENTIST
Credential: DMD
Phone: 843-779-9588