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NPI Code Detail

MEDICARE: AFFORDABLE DENTURES - NORTH CHARLESTON, P. C.

MEDICARE: AFFORDABLE DENTURES - NORTH 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
1122300000XDentist3405SC

General Provider Information

NPI Number : 1407194772
Entity Type Code : Organization
Provider Name (Legal Business Name) : AFFORDABLE DENTURES - NORTH 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 : 843-744-9374
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 : 843-744-9374
Authorized Official
Title or Position : OWNER
Name : DR. DAVID RAY HUDNALL
Credential : DMD
Telephone Number : 843-744-8338
Provider Enumeration Date : 01/22/2013
Last Update Date : 01/22/2013

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