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General NPI Number Information
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NPI Number | 1811271216
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Entity Type | Organization
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Legal Business Name | COSTA AND WILLIAMS DENTAL CARE, LLC
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 325 FOLLY RD STE 310
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City | CHARLESTON
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State | SC
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Zip | 29412-2507
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Country | US
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Telephone | 843-737-4437
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Fax | 843-737-4723
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Provider Business Mailing Address
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Address Line | 325 FOLLY RD STE 310
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City | CHARLESTON
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State | SC
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Zip | 29412-2507
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Country | US
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Telephone | 843-737-4437
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Fax | 843-737-4723
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Authorized Official
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Title or Position | PARTNER
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Name | DR. CHRISTOPHER SHERMAN COSTA
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Credential | DMD
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Telephone | 843-693-4902
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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 | 6968
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4589
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License Number State | SC
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