MEDICARE: JEBEDIAH S. CHRISTY, D.D.S.- NORTH CHARLESTON, PLLC

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	8613	SC

General Provider Information

NPI Number	:	1811433725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEBEDIAH S. CHRISTY, D.D.S.- NORTH CHARLESTON, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:	315-454-6000
Fax Number	:	315-410-5531

Provider Business Practice Location Address
First Line	:	7398 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4613
Country	:	US
Telephone Number	:	843-405-5800
Fax Number	:	843-553-0522

Authorized Official
Title or Position	:	OWNER/DDS
Name	:	JEBEDIAH CHRISTY
Credential	:
Telephone Number	:	843-405-5800

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	01/17/2017

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