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General NPI Number Information
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NPI Number | 1326206129
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Entity Type | Organization
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Legal Business Name | NASH ORTHODONTICS PRACTICE LLC
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 05/28/2008
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Provider Practice Location Address
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Address Line | 1127 QUEENSBOROUGH BLVD SUITE 107
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-5431
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Country | US
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Telephone | 843-884-6336
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Fax |
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Provider Business Mailing Address
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Address Line | 1127 QUEENSBOROUGH BLVD SUITE 107
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-5431
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Country | US
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Telephone | 843-884-6336
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. TRAVIS D NASH
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Credential | DDS
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Telephone | 843-884-6336
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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 | 4149
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License Number State | SC
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