Healthcare Provider Details

I. General information

NPI: 1881618247
Provider Name (Legal Business Name): JAMES DAVID HART DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 PALM BLVD SUITE A
ISLE OF PALMS SC
29451-2297
US

IV. Provider business mailing address

1204 PALM BLVD SUITE A
ISLE OF PALMS SC
29451-2297
US

V. Phone/Fax

Practice location:
  • Phone: 843-886-3836
  • Fax: 843-886-5514
Mailing address:
  • Phone: 843-886-3836
  • Fax: 843-886-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3527
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: