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General NPI Number Information
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NPI Number | 1245052729
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Entity Type | Organization
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Legal Business Name | SFD NORTH CHARLESTON
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 7481 NORTHSIDE DR
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City | NORTH CHARLESTON
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State | SC
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Zip | 29420-4282
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Country | US
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Telephone | 843-871-0842
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Fax |
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Provider Business Mailing Address
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Address Line | 1971 N MAIN ST
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City | SUMMERVILLE
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State | SC
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Zip | 29486-7890
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Country | US
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Telephone | 843-871-0842
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | ANGIE BAZZLE
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Credential |
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Telephone | 843-871-0842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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