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General NPI Number Information
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NPI Number | 1689710758
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Entity Type | Organization
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Legal Business Name | OLD TROLLEY DENTAL ASSOC PA
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 600 OLD TROLLEY RD SUITE A
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City | SUMMERVILLE
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State | SC
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Zip | 29485-5657
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Country | US
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Telephone | 843-871-2971
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Fax | 843-871-7412
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Provider Business Mailing Address
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Address Line | 600 OLD TROLLEY RD SUITE A
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City | SUMMERVILLE
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State | SC
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Zip | 29485-5657
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Country | US
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Telephone | 843-871-2971
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Fax | 843-871-7412
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WILLIAM S. KIBLER
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Credential | DMD
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Telephone | 843-871-2971
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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 | 3872
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License Number State | SC
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