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NPI Code Detail

MEDICARE: CROWFIELD AT NORTH CHARLESTON, LLC

MEDICARE: CROWFIELD AT NORTH CHARLESTON, 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 Dentistry3808SC

General Provider Information

NPI Number : 1508287863
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROWFIELD AT NORTH CHARLESTON, LLC
Provider Business Mailing Address
First Line : 8310 RIVERS AVE
Second Line : SUITE D
City : NORTH CHARLESTON
State : SC
Zip : 29406-9268
Country : US
Telephone Number : 843-797-7200
Fax Number : 843-797-8293
Provider Business Practice Location Address
First Line : 8310 RIVERS AVE
Second Line : SUITE D
City : NORTH CHARLESTON
State : SC
Zip : 29406-9268
Country : US
Telephone Number : 843-797-7200
Fax Number : 843-797-8293
Authorized Official
Title or Position : OWNER
Name : DR. THOMAS BRADLEY WILLIAMS
Credential : DMD
Telephone Number : 843-797-7200
Provider Enumeration Date : 01/03/2014
Last Update Date : 01/03/2014

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Directions to “CROWFIELD AT NORTH CHARLESTON, LLC ” Practice Location

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