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General NPI Number Information
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NPI Number | 1790020907
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Entity Type | Organization
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Legal Business Name | DENTISTRY FOR CHILDREN OF SOUTH CAROLINA, PC
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 1470 TOBIAS GADSON BLVD SUITE 100
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City | CHARLESTON
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State | SC
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Zip | 29407-4707
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Country | US
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Telephone | 843-571-5644
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Fax |
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Provider Business Mailing Address
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Address Line | 2970 BRANDYWINE RD STE 200
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City | ATLANTA
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State | GA
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Zip | 30341-5549
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Country | US
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Telephone | 770-692-1000
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Fax | 678-444-4152
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | JO ANN RICE
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Credential |
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Telephone | 470-881-8679
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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 | 3253
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License Number State | SC
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