Healthcare Provider Details

I. General information

NPI: 1518375054
Provider Name (Legal Business Name): ERIC OLENDORF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 N HIGHWAY 17
MOUNT PLEASANT SC
29466-6925
US

IV. Provider business mailing address

3102 N HIGHWAY 17
MOUNT PLEASANT SC
29466-6925
US

V. Phone/Fax

Practice location:
  • Phone: 843-970-7292
  • Fax:
Mailing address:
  • Phone: 843-970-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401414533
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS-10435
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9601
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9530
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414533
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: