Healthcare Provider Details

I. General information

NPI: 1366368763
Provider Name (Legal Business Name): SOLOMON DENTAL SEDATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 W BUTTERNUT RD STE 201
SUMMERVILLE SC
29483-5585
US

IV. Provider business mailing address

1971 N MAIN ST
SUMMERVILLE SC
29486-7890
US

V. Phone/Fax

Practice location:
  • Phone: 843-871-0842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: ANGIE BAZZLE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 843-871-0842