Healthcare Provider Details

I. General information

NPI: 1306026471
Provider Name (Legal Business Name): 3DI DIAGNOSTIC ORAL FACIAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 TWO ISLAND CT SUITE 103B
MT PLEASANT SC
29466-7405
US

IV. Provider business mailing address

1203 TWO ISLAND CT SUITE 103B
MT PLEASANT SC
29466-7405
US

V. Phone/Fax

Practice location:
  • Phone: 843-849-7929
  • Fax: 843-849-7117
Mailing address:
  • Phone: 843-849-7929
  • Fax: 843-849-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. COURTNEY W. SHELBOURNE
Title or Position: OWNER
Credential:
Phone: 843-849-7929