MEDICARE: CHARLES TOWNE FAMILY AND COSMETIC DENTISTRY

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	1223G0001X	General Practice Dentistry	4629	SC

General Provider Information

NPI Number	:	1649571019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES TOWNE FAMILY AND COSMETIC DENTISTRY

Provider Business Mailing Address
First Line	:	1677 SAVANNAH HIGHWAY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6256
Country	:	US
Telephone Number	:	843-556-6575
Fax Number	:	843-556-0207

Provider Business Practice Location Address
First Line	:	1677 SAVANNAH HIGHWAY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6256
Country	:	US
Telephone Number	:	843-556-6575
Fax Number	:	843-556-0207

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREG ORSIMARSI II
Credential	:	DMD
Telephone Number	:	843-556-6575

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	09/20/2023

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