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General NPI Number Information
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NPI Number | 1043301146
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Entity Type | Organization
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Legal Business Name | LOWCOUNTRY CENTER FOR PROSTHODONTIC CARE
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 25 CLARK SUMMIT DR
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City | BLUFFTON
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State | SC
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Zip | 29910-4205
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Country | US
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Telephone | 843-706-3800
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Fax | 843-706-3802
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Provider Business Mailing Address
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Address Line | 25 CLARK SUMMIT DR
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City | BLUFFTON
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State | SC
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Zip | 29910-4205
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Country | US
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Telephone | 843-706-3800
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Fax | 843-706-3802
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Authorized Official
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Title or Position | DENTIST
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Name | VIRGIL VACAREAN
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Credential | DMD
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Telephone | 843-706-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3764
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 0585
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License Number State | SC
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