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General NPI Number Information
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NPI Number | 1538603303
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Entity Type | Organization
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Legal Business Name | PLANTATION FAMILY DENTALCARE
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 1859 SAVAGE RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4726
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Country | US
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Telephone | 843-722-5733
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Fax |
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Provider Business Mailing Address
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Address Line | 1859 SAVAGE RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4726
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Country | US
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Telephone | 843-722-5733
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ERIC E RADABAUGH
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Credential | MBA
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Telephone | 843-364-6695
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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 | 8533
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License Number State | SC
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