Healthcare Provider Details

I. General information

NPI: 1457478794
Provider Name (Legal Business Name): PAOLO INCAMPO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
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:
Mailing address:
  • Phone: 843-261-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number18656
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number10147
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: