Healthcare Provider Details

I. General information

NPI: 1508511023
Provider Name (Legal Business Name): DENTURECARELLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6185 RIVERS AVE STE P
NORTH CHARLESTON SC
29406-4999
US

IV. Provider business mailing address

997 MORRISON DR STE 200
CHARLESTON SC
29403-4378
US

V. Phone/Fax

Practice location:
  • Phone: 212-843-4032
  • Fax:
Mailing address:
  • Phone: 917-328-6654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: SELENA MARTIN
Title or Position: COO
Credential:
Phone: 917-328-6654