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General NPI Number Information
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NPI Number | 1609316454
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Entity Type | Organization
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Legal Business Name | ARCHDALE FAMILY DENTISTRY ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 5306 PARKSHIRE WAY
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-2000
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Country | US
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Telephone | 843-552-1600
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Fax | 843-552-0049
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Provider Business Mailing Address
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Address Line | 5306 PARKSHIRE WAY
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-2000
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Country | US
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Telephone | 843-552-1600
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Fax | 843-552-0049
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. COLLEEN P. CONDREY
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Credential |
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Telephone | 843-552-1600
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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 | 2785
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6959
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License Number State | SC
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