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General NPI Number Information
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NPI Number | 1356668479
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Entity Type | Organization
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Legal Business Name | CANE BAY ORTHODONTICS
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 597 OLD MOUNT HOLLY RD SUITE 205
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City | GOOSE CREEK
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State | SC
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Zip | 29445-2832
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Country | US
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Telephone | 843-797-7711
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Fax | 843-797-7747
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Provider Business Mailing Address
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Address Line | 597 OLD MOUNT HOLLY RD SUITE 205
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City | GOOSE CREEK
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State | SC
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Zip | 29445-2832
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Country | US
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Telephone | 843-797-7711
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Fax | 843-797-7747
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROLAND K FULCHER
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Credential | DMD
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Telephone | 843-261-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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