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NPI Code Detail

MEDICARE: NORTH CHARLESTON DENTAL ASSOCIATES, LLC

MEDICARE: NORTH CHARLESTON DENTAL ASSOCIATES, LLC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1407113848
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH CHARLESTON DENTAL ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 8310 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9268
Country : US
Telephone Number : 843-797-7200
Fax Number :
Provider Business Practice Location Address
First Line : 8310 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9268
Country : US
Telephone Number : 843-797-7200
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. JOHN F. DUNBAR JR.
Credential : DMD
Telephone Number : 864-573-9255
Provider Enumeration Date : 04/23/2012
Last Update Date : 04/23/2012

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