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General NPI Number Information
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NPI Number | 1952915027
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Entity Type | Organization
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Legal Business Name | VDP OKATIE LLC
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 10 WILLIAM POPE DRIVE, SUITE #2
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City | OKATIE
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State | SC
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Zip | 29909
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Country | US
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Telephone | 843-705-7066
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Fax |
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Provider Business Mailing Address
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Address Line | 3919 AMSTATE RD
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City | LEO
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State | IN
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Zip | 46765
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Country | US
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Telephone | 260-312-5794
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Fax | 260-627-5825
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Authorized Official
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Title or Position | DENTIST/OWNER OF PRACTICE
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Name | BRADLEY DANIEL HUGHES
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Credential | DMD
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Telephone | 260-312-5794
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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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