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General NPI Number Information
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NPI Number | 1649825969
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Entity Type | Organization
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Legal Business Name | OAK LANDING PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 08/04/2019
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 2001 2ND AVE STE 102
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City | SUMMERVILLE
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State | SC
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Zip | 29486-7887
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Country | US
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Telephone | 843-900-4490
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Fax | 843-501-9450
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Provider Business Mailing Address
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Address Line | 3255 MOONLIGHT DR
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City | CHARLESTON
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State | SC
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Zip | 29414-8052
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Country | US
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Telephone | 803-537-9136
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. GABRIEL N ROSS
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Credential | DMD
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Telephone | 843-900-4490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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