MEDICARE: PARKWOOD DENTAL ASSOCIATES, PA

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	3847	SC

General Provider Information

NPI Number	:	1679665830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKWOOD DENTAL ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	1247A SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7826
Country	:	US
Telephone Number	:	843-571-6795
Fax Number	:	843-556-7309

Provider Business Practice Location Address
First Line	:	1247A SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7826
Country	:	US
Telephone Number	:	843-571-6795
Fax Number	:	843-556-7309

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TODD RUTLEDGE SANDER
Credential	:	DMD
Telephone Number	:	843-571-6795

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/22/2020

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