Healthcare Provider Details

I. General information

NPI: 1538074919
Provider Name (Legal Business Name): GAVIN L CRISER DDS MS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHEROKEE RD STE B
FLORENCE SC
29501-5225
US

IV. Provider business mailing address

220 CHEROKEE RD STE B
FLORENCE SC
29501-5225
US

V. Phone/Fax

Practice location:
  • Phone: 843-662-3336
  • Fax: 843-667-9211
Mailing address:
  • Phone: 843-662-3336
  • Fax: 843-667-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: GAVIN L CRISER
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 843-662-3336