Healthcare Provider Details

I. General information

NPI: 1922569656
Provider Name (Legal Business Name): FAMILY LASER DENTAL OF NORTH CHARLESTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 CROSS COUNTY RD STE 4
NORTH CHARLESTON SC
29418-8470
US

IV. Provider business mailing address

7455 CROSS COUNTY RD STE 4
NORTH CHARLESTON SC
29418-8470
US

V. Phone/Fax

Practice location:
  • Phone: 843-552-4771
  • Fax:
Mailing address:
  • Phone: 843-552-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR NICHOLAS SAVASTANO
Title or Position: OWNER
Credential:
Phone: 843-642-8100