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General NPI Number Information
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NPI Number | 1679665830
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Entity Type | Organization
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Legal Business Name | PARKWOOD DENTAL ASSOCIATES, PA
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1247A SAVANNAH HWY
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City | CHARLESTON
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State | SC
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Zip | 29407-7826
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Country | US
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Telephone | 843-571-6795
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Fax | 843-556-7309
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Provider Business Mailing Address
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Address Line | 1247A SAVANNAH HWY
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City | CHARLESTON
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State | SC
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Zip | 29407-7826
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Country | US
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Telephone | 843-571-6795
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Fax | 843-556-7309
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TODD RUTLEDGE SANDER
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Credential | DMD
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Telephone | 843-571-6795
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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 | 3847
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License Number State | SC
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