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General NPI Number Information
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NPI Number | 1740568765
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Entity Type | Organization
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Legal Business Name | MOUTH CAROLINA DENTISTRY, PA
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 3 GAMECOCK AVE SUITE 302
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City | CHARLESTON
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State | SC
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Zip | 29407-3378
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Country | US
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Telephone | 843-556-4798
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Fax | 843-556-4798
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Provider Business Mailing Address
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Address Line | 3 GAMECOCK AVE SUITE 302
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City | CHARLESTON
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State | SC
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Zip | 29407-3378
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Country | US
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Telephone | 843-556-4798
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Fax | 843-556-4798
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANDREW WILLIAM GREENBERG
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Credential | DMD
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Telephone | 843-260-4592
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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 | 4643
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License Number State | SC
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