MEDICARE: DR. ERIC OLENDORF DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401414533	VA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DDS-10435	IA
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	9601	SC
4	122300000X	Dentist	9530	SC
5	122300000X	Dentist	0401414533	VA

General Provider Information

NPI Number	:	1518375054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC OLENDORF DDS

Provider Business Mailing Address
First Line	:	3102 N HIGHWAY 17
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-6925
Country	:	US
Telephone Number	:	843-970-7292
Fax Number	:

Provider Business Practice Location Address
First Line	:	3102 N HIGHWAY 17
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-6925
Country	:	US
Telephone Number	:	843-970-7292
Fax Number	:

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

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	03/26/2026

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