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General NPI Number Information
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NPI Number | 1952517161
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Entity Type | Organization
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Legal Business Name | MUSC COLLEGE OF DENTAL MEDICINE
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 29 BEE ST
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City | CHARLESTON
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State | SC
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Zip | 29425-0001
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Country | US
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Telephone | 843-876-7645
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 737811
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City | DALLAS
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State | TX
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Zip | 75373-7811
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Country | US
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Telephone | 843-876-7645
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE ACADEMIC PROG DIRECTOR
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Name | JOHN BALLENTINE
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Credential |
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Telephone | 843-792-2441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | SC-3198
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License Number State | SC
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