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General NPI Number Information
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NPI Number | 1821248394
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Entity Type | Organization
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Legal Business Name | AIKEN ENDODONTICS
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 105 SUMMERWOOD WAY SUITE C
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City | AIKEN
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State | SC
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Zip | 29803-7713
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Country | US
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Telephone | 803-649-1771
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Fax | 803-641-1311
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Provider Business Mailing Address
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Address Line | 105 SUMMERWOOD WAY SUITE C
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City | AIKEN
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State | SC
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Zip | 29803-7713
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Country | US
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Telephone | 803-649-1771
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Fax | 803-641-1311
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES WESTON
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Credential |
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Telephone | 803-649-1771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4402
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License Number State | SC
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