MEDICARE: DR. CARRIE S NIEMANN D.D.S

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	122300000X	Dentist	3830	SC

General Provider Information

NPI Number	:	1790761633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE S NIEMANN D.D.S

Provider Business Mailing Address
First Line	:	8471 RESOLUTE WAY
Second Line	:	SUITE 104
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7381
Country	:	US
Telephone Number	:	843-760-6565
Fax Number	:	843-760-6484

Provider Business Practice Location Address
First Line	:	8471 RESOLUTE WAY
Second Line	:	SUITE 104
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7381
Country	:	US
Telephone Number	:	843-760-6565
Fax Number	:	843-760-6484

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/27/2023

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