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General NPI Number Information
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NPI Number | 1366086621
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Entity Type | Organization
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Legal Business Name | TGD-SUMMERVILLE LLC
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 604-A NEXTON SQUARE DR
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City | SUMMERVILLE
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State | SC
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Zip | 29486
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Country | US
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Telephone | 843-552-2580
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Fax | 843-871-0453
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Provider Business Mailing Address
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Address Line | 604-A NEXTON SQUARE DR
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City | SUMMERVILLE
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State | SC
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Zip | 29486
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Country | US
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Telephone | 843-552-2580
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ERIC JAMES LAYTON
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Credential | DENTIST
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Telephone | 843-552-2580
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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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