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General NPI Number Information
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NPI Number | 1841638376
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Entity Type | Organization
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Legal Business Name | BLUFFTON CENTER FOR DENTISTRY
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 29 PLANTATION PARK DR STE#303,304
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City | BLUFFTON
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State | SC
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Zip | 29910-9001
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Country | US
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Telephone | 843-593-8123
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Fax |
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Provider Business Mailing Address
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Address Line | 29 PLANTATION PARK DR STE#303,304
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City | BLUFFTON
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State | SC
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Zip | 29910-9001
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Country | US
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Telephone | 843-593-8123
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RICHARD F PORCELLI
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Credential | DDS
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Telephone | 843-441-8852
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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 | 8083
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4659
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1985
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4530
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License Number State | SC
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