Healthcare Provider Details

I. General information

NPI: 1033072145
Provider Name (Legal Business Name): LIFEHOUSE DENTAL AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3137 HIGHWAY 9
CHERAW SC
29520-6633
US

IV. Provider business mailing address

PO BOX 1000
CHERAW SC
29520-1000
US

V. Phone/Fax

Practice location:
  • Phone: 843-253-5322
  • Fax: 843-253-5214
Mailing address:
  • Phone: 853-253-5322
  • Fax: 843-253-5214

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: CHARU CLIFFORD
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 843-253-5322