Healthcare Provider Details

I. General information

NPI: 1619359627
Provider Name (Legal Business Name): DEBRA GANDY ADAMS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 ARUNDEL PL
MT PLEASANT SC
29464-6201
US

IV. Provider business mailing address

2053 ARUNDEL PL
MT PLEASANT SC
29464-6201
US

V. Phone/Fax

Practice location:
  • Phone: 843-225-3353
  • Fax:
Mailing address:
  • Phone: 843-225-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8487
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: