Healthcare Provider Details

I. General information

NPI: 1497901623
Provider Name (Legal Business Name): DENTALWORKS AT ROCK HILL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 DAVE LYLE BLVD. SUITE #101
ROCK HILL SC
29730-8238
US

IV. Provider business mailing address

PO BOX 860036
MINNEAPOLIS MN
55486-0036
US

V. Phone/Fax

Practice location:
  • Phone: 803-325-9000
  • Fax: 216-584-1150
Mailing address:
  • Phone: 803-325-9000
  • Fax: 216-584-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES ZASSO
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 803-325-9000