Healthcare Provider Details

I. General information

NPI: 1356275879
Provider Name (Legal Business Name): ZAKHAR ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 RIVERWALK BLVD STE 6
RIDGELAND SC
29936-8191
US

IV. Provider business mailing address

149 RIVERWALK BLVD STE 6
RIDGELAND SC
29936-8191
US

V. Phone/Fax

Practice location:
  • Phone: 854-213-5566
  • Fax:
Mailing address:
  • Phone: 854-213-5566
  • Fax:

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: GRANT ZAKHAR
Title or Position: OWNER
Credential: DDS, MSD
Phone: 708-259-7663