Healthcare Provider Details

I. General information

NPI: 1689988198
Provider Name (Legal Business Name): RAMAN ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 ST. ANDREWS RD. SUITE D
IRMO SC
29063
US

IV. Provider business mailing address

7321 ST. ANDREWS RD. SUITE D
IRMO SC
29063
US

V. Phone/Fax

Practice location:
  • Phone: 803-749-4001
  • Fax:
Mailing address:
  • Phone: 803-749-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES WESLEY RAMAN
Title or Position: PRESIDENT
Credential: DMD
Phone: 803-269-8841