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General NPI Number Information
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NPI Number | 1619029071
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Entity Type | Individual
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Provider Name | RAYMOND CARY BOCKLET DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 1845 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 | 843-556-2133
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Fax | 843-556-2199
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Provider Business Mailing Address
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Address Line | 1845 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 | 843-556-2133
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Fax | 843-556-2199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3154 SPECIALTY 0443
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License Number State | SC
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