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General NPI Number Information
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NPI Number | 1508280991
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE DENTISTRY FOR ADULTS INC
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 1470 TOBIAS GADSON BLVD SUITE 100B
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City | CHARLESTON
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State | SC
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Zip | 29407-4707
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Country | US
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Telephone | 843-556-9939
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Fax | 843-769-6625
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Provider Business Mailing Address
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Address Line | 1470 TOBIAS GADSON BLVD SUITE 100B
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City | CHARLESTON
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State | SC
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Zip | 29407-4707
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Country | US
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Telephone | 843-556-9939
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Fax | 843-769-6625
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | JAMES C LESCH
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Credential | DDS
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Telephone | 843-556-9939
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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 | 6898
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3382
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License Number State | SC
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