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General NPI Number Information
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NPI Number | 1508598384
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Entity Type | Organization
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Legal Business Name | CAROLINA ELITE DENTAL
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | KINGSTON VILLAGE DENTISTRY 900 A MAIN STREET
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City | CONWAY
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State | SC
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Zip | 29526-2952
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Country | US
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Telephone | 843-488-3710
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Fax |
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Provider Business Mailing Address
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Address Line | 11 CUNNINGTON AVE
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City | CHARLESTON
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State | SC
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Zip | 29405-9312
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Country | US
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Telephone | 912-660-3432
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | CINDY M HAWKINS
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Credential |
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Telephone | 912-660-3432
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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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