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General NPI Number Information
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NPI Number | 1225708373
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Entity Type | Organization
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Legal Business Name | OLD TROLLEY DENTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 600 OLD TROLLEY RD
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City | SUMMERVILLE
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State | SC
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Zip | 29485-5686
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Country | US
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Telephone | 843-871-2971
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Fax | 843-871-7412
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Provider Business Mailing Address
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Address Line | 600 OLD TROLLEY RD
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City | SUMMERVILLE
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State | SC
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Zip | 29485-5686
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Country | US
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Telephone | 843-871-2971
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Fax | 843-871-7412
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. WILLIAM SCOTT KIBLER
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Credential | DMD
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Telephone | 843-871-2971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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