Healthcare Provider Details

I. General information

NPI: 1205894474
Provider Name (Legal Business Name): CHILDREN'S DENTISTRY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7465 NORTHSIDE DR
NORTH CHARLESTON SC
29420-4209
US

IV. Provider business mailing address

7465 NORTHSIDE DR
NORTH CHARLESTON SC
29420-4209
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-5400
  • Fax: 843-797-5164
Mailing address:
  • Phone: 843-797-5400
  • Fax: 843-797-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES C BEALL
Title or Position: PRESIDENT
Credential: D.D.S
Phone: 843-797-1118