Healthcare Provider Details

I. General information

NPI: 1689430142
Provider Name (Legal Business Name): HARMONY ORAL AND FACIAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 STONECREST BLVD, UNIT 105
TEGA CAY SC
29708-2970
US

IV. Provider business mailing address

14445 W S LEE CT
CHARLOTTE NC
28277-3709
US

V. Phone/Fax

Practice location:
  • Phone: 839-400-2244
  • Fax: 839-400-2230
Mailing address:
  • Phone: 864-363-1879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RIDDHI PATEL
Title or Position: ORAL SURGEON
Credential: DMD
Phone: 864-363-1879