Healthcare Provider Details

I. General information

NPI: 1124434329
Provider Name (Legal Business Name): JAMES C. ANDREWS DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 TROLLEY ROAD
SUMMERVILLE SC
29485
US

IV. Provider business mailing address

1720 TROLLEY ROAD
SUMMERVILLE SC
29485
US

V. Phone/Fax

Practice location:
  • Phone: 843-871-6351
  • Fax: 843-871-7558
Mailing address:
  • Phone: 843-871-6351
  • Fax: 843-871-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: DR. JAMES CHARLES ANDREWS
Title or Position: DENTIST
Credential: DMD
Phone: 843-871-6351