MEDICARE: DR. CHARLES WILLIAM CULP D.M.D

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
1	1223G0001X	General Practice Dentistry	7112	SC

General Provider Information

NPI Number	:	1295005130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES WILLIAM CULP D.M.D

Provider Business Mailing Address
First Line	:	1334 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2337
Country	:	US
Telephone Number	:	803-324-2921
Fax Number	:	803-324-2491

Provider Business Practice Location Address
First Line	:	1334 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2337
Country	:	US
Telephone Number	:	803-324-2921
Fax Number	:	803-324-2491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	04/26/2018

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