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General NPI Number Information
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NPI Number | 1346464674
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CHILDREN'S DENTISTRY, P.A.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2075-A CHARLIE HALL BLVD.
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City | CHARLESTON
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State | SC
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Zip | 29414-5834
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Country | US
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Telephone | 843-556-1655
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Fax | 843-556-1656
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Provider Business Mailing Address
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Address Line | 2075-A CHARLIE HALL BLVD.
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City | CHARLESTON
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State | SC
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Zip | 29414-5834
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Country | US
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Telephone | 843-556-1655
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Fax | 843-556-1656
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PAUL A GALLOWAY
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Credential | D.M.D.
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Telephone | 843-556-1655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3956
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License Number State | SC
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