Healthcare Provider Details

I. General information

NPI: 1831638873
Provider Name (Legal Business Name): ORAL SURGERY OF SOUTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 RIVERS AVE SUITE 1650
N CHARLESTON SC
29406-4057
US

IV. Provider business mailing address

1350 SPRING ST NW SUITE 600
ATLANTA GA
30309-2870
US

V. Phone/Fax

Practice location:
  • Phone: 770-692-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MARGARET REBECCA SANDERS WARD
Title or Position: OWNER
Credential: DMD
Phone: 678-244-4844