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NPI Code Detail

MEDICARE: CHARLESTON DENTURE CENTER - NORHT CHARLESTON, P.C.

MEDICARE: CHARLESTON DENTURE CENTER - NORHT CHARLESTON, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist4470SC

General Provider Information

NPI Number : 1033371927
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLESTON DENTURE CENTER - NORHT CHARLESTON, P.C.
Provider Business Mailing Address
First Line : 5711 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6028
Country : US
Telephone Number : 843-744-8338
Fax Number :
Provider Business Practice Location Address
First Line : 5711 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6028
Country : US
Telephone Number : 843-744-8338
Fax Number :
Authorized Official
Title or Position : DMD
Name : TERRY BROWN
Credential :
Telephone Number : 843-744-8338
Provider Enumeration Date : 07/01/2008
Last Update Date : 07/01/2008

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