Healthcare Provider Details

I. General information

NPI: 1023231255
Provider Name (Legal Business Name): CHARLES GAITHER BUMGARDNER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 ALSTON CIR
LEXINGTON SC
29072-7317
US

IV. Provider business mailing address

240 ALSTON CIR
LEXINGTON SC
29072-7317
US

V. Phone/Fax

Practice location:
  • Phone: 803-315-8788
  • Fax:
Mailing address:
  • Phone: 803-315-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2780
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: