MEDICARE: OAK POINT PEDIATRIC DENTISTRY, 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
1	1223P0221X	Pediatric Dentistry	3467	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487712535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK POINT PEDIATRIC DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	1721 OAK POINT RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2838
Country	:	US
Telephone Number	:	843-795-8787
Fax Number	:	843-795-8717

Provider Business Practice Location Address
First Line	:	1721 OAK POINT RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2838
Country	:	US
Telephone Number	:	843-795-8787
Fax Number	:	843-795-8717

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIN LEWIS NICHOLS
Credential	:	D.M.D.
Telephone Number	:	843-795-8787

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/22/2020

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