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General NPI Number Information
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NPI Number | 1407576465
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Entity Type | Organization
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Legal Business Name | RIVER LANDING DENTISTRY WEST SUMMERVILLE LLC
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 2636 HIGHWAY 17A S STE A
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City | SUMMERVILLE
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State | SC
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Zip | 29483-9114
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Country | US
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Telephone | 843-242-0645
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Fax |
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Provider Business Mailing Address
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Address Line | 145 RIVER LANDING DR UNIT 102
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City | DANIEL ISLAND
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State | SC
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Zip | 29492-8612
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Country | US
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Telephone | 843-242-0645
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Fax |
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Authorized Official
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Title or Position | ITS MEMBER
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Name | DR. REBECA ZECHMANN
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Credential | DDS
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Telephone | 843-242-0645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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