Healthcare Provider Details

I. General information

NPI: 1760084560
Provider Name (Legal Business Name): TEETH DS DANIEL ISLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 SEVEN FARMS DR STE 101
DANIEL ISLAND SC
29492-8988
US

IV. Provider business mailing address

240 SEVEN FARMS DR STE 101
DANIEL ISLAND SC
29492-8988
US

V. Phone/Fax

Practice location:
  • Phone: 843-284-4444
  • Fax:
Mailing address:
  • Phone: 843-284-4444
  • 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: DR. LUKE LISZKA
Title or Position: OWNER
Credential:
Phone: 403-909-0302