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General NPI Number Information
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NPI Number | 1972917680
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Entity Type | Organization
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Legal Business Name | SWEETGRASS PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 102 W 8TH NORTH ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6656
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Country | US
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Telephone | 843-471-1135
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Fax |
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Provider Business Mailing Address
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Address Line | 102 W 8TH NORTH ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6656
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Country | US
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Telephone | 843-471-1135
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DENNIS K SCHIMPF
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Credential | M.D.
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Telephone | 843-471-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | MD28924
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License Number State | SC
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