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General NPI Number Information
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NPI Number | 1043192057
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Entity Type | Organization
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Legal Business Name | PERIOCARE LLC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 3070 N HIGHWAY 17 STE 202
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City | MT PLEASANT
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State | SC
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Zip | 29466-9300
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Country | US
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Telephone | 843-650-7171
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Fax |
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Provider Business Mailing Address
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Address Line | 3070 N HIGHWAY 17 STE 202
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City | MT PLEASANT
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State | SC
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Zip | 29466-9300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. NEDA AZADIVATAN
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Credential | DDS
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Telephone | 843-650-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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