Healthcare Provider Details

I. General information

NPI: 1104743590
Provider Name (Legal Business Name): DORCHESTER ORTHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8626 DORCHESTER RD STE 102
NORTH CHARLESTON SC
29420-7328
US

IV. Provider business mailing address

8626 DORCHESTER RD STE 102
NORTH CHARLESTON SC
29420-7328
US

V. Phone/Fax

Practice location:
  • Phone: 843-261-2001
  • Fax: 843-738-6942
Mailing address:
  • Phone: 843-261-2001
  • Fax: 843-738-6942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNI TOMLINSON
Title or Position: CREDENTIALING AND ENROLLMENT
Credential:
Phone: 470-552-1823