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General NPI Number Information
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NPI Number | 1801766746
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Entity Type | Organization
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Legal Business Name | AVONDALE FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 765 SAINT ANDREWS BLVD
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City | CHARLESTON
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State | SC
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Zip | 29407-7164
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Country | US
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Telephone | 843-766-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 765 SAINT ANDREWS BLVD
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City | CHARLESTON
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State | SC
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Zip | 29407-7164
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Country | US
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Telephone | 843-766-5333
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | WENDY HAEFNER
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Credential |
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Telephone | 843-513-5248
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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 |
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License Number State |
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